Making the invisible visible: the current face of tuberculosis in Detroit, Michigan, USA

ABSTRACT

To describe the socioeconomic inequities among individuals with tuberculosis (TB) in metropolitan Detroit. We used data from the TB Social Survey to examine socioeconomic and demographic characteristics among individuals diagnosed with TB in one of three metropolitan Detroit health departments. We then examined mean levels of both economic disadvantage and socioeconomic instability across levels of race/ethnicity, nativity, and health department. Sixty-seven percent of individuals with TB in Detroit City were non-Hispanic Black, compared to 27% and 25% in Oakland County and Wayne County (excluding Detroit), respectively. Non-Hispanic Blacks, U.S.-born individuals, and those living in Detroit City had higher mean levels of both economic disadvantage and socioeconomic instability compared to non-Hispanic Whites, foreign-born individuals and those living in Wayne (excluding Detroit City) or Oakland County. The findings from this study highlight the ways in which TB is distributed along lines of socioeconomic disadvantage. This suggests that enduring inequities in socioeconomic resources may be contributing to inequities in TB disease, a trend that likely to continue with worsening socioeconomic disparities in the U.S.

KEYWORDS:

• Socioeconomic disparities
• tuberculosis
• social determinants of health
• urban health

This article is related to:

Research for city practice

Acknowledgements

The authors are grateful for the support of Dr. Peter Davidson and the Michigan Department of Health and Human Services. The support of Dr. Davidson has been invaluable in building the infrastructure for this project, including building relationships with the local health departments.

Additionally, the authors are immensely grateful to the Oakland County Health Department, the Wayne State Physicians Group, and the Wayne County Health Department without whom this study would not have been possible. Their expertise and insights have been invaluable to the development of this study. Specifically, the authors would like to acknowledge Pamela Hackert, MD JD MPH; Janice Taylor, RN; and Laura Frederick, RN for the countless hours spent with the study team, educating them on the on-the-ground experience of TB control. This education and support has been instrumental to the study and is most appreciated.

Finally, the authors are incredibly grateful to the individuals with TB who generously gave their time and energy to participate in this study. This work is dedicated to making their stories heard.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by a research grant from the Horace H. Rackham School of Graduate Studies, University of Michigan. GAN received salary support from the National Institute on Aging (K99AG062749-01A1), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32 HD091058) and from the Carolina Population Center (P2C HD050924).

Notes on contributors

Grace A. Noppert

Grace A. Noppert is a Postdoctoral Scholar at the Carolina Population Center at the University of North Carolina, Chapel Hill. Her work examines how social processes across the life course, particularly structural disadvantage, impact a person’s biology through exposure to infections.

Philippa Clarke

Philippa Clarke is a Research Professor in the University of Michigan's Institute for Social Research and a Professor in the Department of Epidemiology, University of Michigan. Her work focuses on understanding the role of neighborhood context for exacerbating and ameliorating health inequalities across the life course.