RESUMEN
OBJECTIVE: We assessed demographic and temporal trends of tuberculosis (TB)-related deaths in the United States and examined associated comorbidities listed on death certificates. METHODS: We analyzed TB-related mortality from 1990 through 2006 by examining multiple-cause-of-death data from the National Center for Health Statistics. We assessed age-adjusted mortality rates, secular trends, associations with demographic variables, and comorbid conditions. RESULTS: From 1990 through 2006, TB was reported as a cause of death among 53,505 people in the U.S. with a combined overall mean age-adjusted mortality rate of 1.16 per 100,000 person-years. The age-adjusted TB mortality rate declined from 2.22 per 100,000 person-years in 1990 to 0.47 per 100,000 person-years in 2006, demonstrating mean annual decline of about 10%. People aged 75 years and older; males; foreign-born people; and those of Hispanic, Asian, black, and Native American race/ethnicity had comparatively elevated TB-related mortality rates. The mortality rate in foreign-born people was more than two times higher than in U.S.-born people. About 89% of deaths among people of Asian race/ethnicity and nearly 50% among black people were foreign-born individuals. Human immunodeficiency virus and selected autoimmune diseases were more common in TB-related deaths. CONCLUSIONS: TB mortality decreased substantially from 1990 through 2006, but remains an important cause of preventable mortality. The observed decrease was more pronounced among U.S.-born people than among foreign-born people. Disparities in TB-related mortality and the identification of important comorbid conditions can inform strategies targeting subpopulations at increased risk for fatal TB infection.
Asunto(s)
Tuberculosis/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Preescolar , Comorbilidad , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Distribución de Poisson , Análisis de Regresión , Tuberculosis/epidemiología , Tuberculosis/etnología , Estados Unidos/epidemiologíaRESUMEN
The direct and indirect costs of suspected human rabies exposure were estimated for San Luis Obispo and Santa Barbara counties, California, USA. Clinic, hospital, and county public health records (1998-2002) were examined to determine direct costs for postexposure prophylaxis (PEP), and 55 (41%) former patients were contacted to voluntarily provide estimates of their indirect costs associated with receiving PEP. Additional costs due to public health and animal control personnel responses to rabid animals were collected, including diagnostic testing and wages. The mean total cost of a suspected human rabies exposure was $3,688, the direct costs per case were $2,564, and the indirect costs were $1,124 of that total. About one third of the total cost for suspected human rabies exposure was attributed to indirect costs (e.g., lost wages, transportation, and day-care fees), most of which were not reimbursable to the patient.