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COH 315 Ashford University HIV Epidemiology Chronic Disease Paper

COH 315

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Chronic Disease Report: Develop a 5 page, research paper on the epidemiology of a significant chronic disease or condition. Include distribution, prevalence, risk factors, criteria for causation and preventive measures. Use research and data to support the paper. Use APA form and style.


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THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES COH 315: Introduction to Epidemiology National University 1 THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES 2 The significance of Tuberculosis in the United States Tuberculosis (TB) is a common infectious bacterial disease that affects the lungs and in rare cases, other parts of the body such as kidney and bones. TB poses a considerable threat to public health despite popular misconceptions that it is a disease of the past. The disease affects almost one-third of world population and are responsible for 1.5 million deaths every year mostly in developing countries. TB is much less common in the United States of American and according to statistics, only about 10,500 people were diagnosed with the disease in 2011. However, TB causes disproportional infections among people with weak immune systems and foreign-born populace (Glaziou et al., 2013). TB burden According to 2011 statistics, African and South East Asia regions carry the heaviest TB burden. African region leads the rest of the world in the number of TB deaths, prevalence, and incidence. The Americas region has one of the least world’s TB burden compared to the rest of the region. The number of TB deaths, excluding HIV in Americas region stands at two per 100,000, while that of Africa and South-East Asia is 26 per 100,000. The TB and HIV prevalence rate (per 100,000 population is 293 in Africa, 271 for South-East Asia, 170 for Eastern Mediterranean, 56 for Europe, and 35 for the Americas. The number of HIV-positive incident TB cases rate per 100,000 people is 102 for Africa, 8 for South-East Asia, 4 for the Americas, 3 for Europe, and one in the Eastern Mediterranean (Glaziou et al., 2013). Distribution and prevalence According to Van Sighem et al. (2015), the United States has maintained data on newly diagnosed cases of TB infection since 1953. TB statistics show that the rate of infections dropped THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES 3 on annual rate of 2.3 percent between 1953 and 1985. During that period, the number of new TB cases declined by 74 percent from 84,304 cases to 22,201 cases. The TB infection rate changed its decline trend and started increasing between 1985 and 1992 because of HIV/AIDS coinfection. During the 1985-92 period, the number of TB infection rose by 20 percent to reach 26,673. Statistics show that the increased TB infection rate during 1985-1992 period contributes to over 64,000 extra TB cases in the U.S. alone. The federal government initiated strategies intended at reversing the rising rate of TB infections that included committing extra resources in order to support TB prevention programs. The government efforts included support programs targeting HIV-infected people, giving the high-risk populations preventive therapy, and wider screening. Statistics show the number of TB cases dropped significantly during the period 19922011. The rate of TB infection rate decreased from 10.5 to 3.4 per 100,000 persons, representing a 76 percent decrease. Demographics (Ethnic) factors Although tuberculosis affect people of all races, statistics show that TB affects certain subgroups in a disproportionate way. Different demographic factors such as age, sex, ethnicity, race, and country of origin show disparity in TB prevalence. Age is a major factor in TB prevalence since statistics show TB cases increases as the age increases. The 2011 U.S TB case rate shows that the TB infection rate is lowest among children aged zero -14 years whose prevalence rate stands at 0.9 per 100,000. People above 65 years have the highest TB infection rate (5.4 per 100,000) compared with the other age groups, who recorded lower rates. For instance, the infection rate among people aged 15- 24 years, 25-44 years, 45-64 years was 2.4, 4.1, and 4.0 per 100,000 respectively. Statistics show that men are 62 percent more likely to get TB infections than women are, with a male TB prevalence rate of 4.2 per 100,000. The TB THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES 4 incidence in men and women decreased by 50 percent, but TB incidence decrease among men was greater than that of women (Walter et al., 2014). According to Lim et al. (2013), race and ethnicity groups show a significant disparity in the number of TB incidence. The 2011 statistics indicate that 83 percent of all TB cases in the United States occur among racial and ethnic groups excluding non-Hispanic whites. American Indian/Native Alaska and the Native Hawaiian or Pacific Islanders accounted for less than one percent of the TB cases. The whites accounted for 16.0 percent, Blacks 23.0 percent, Hispanic, 29.0 percent, and the Asian 30.0 percent. Between 2004-2010 period, Hispanic had the highest TB cases. TB incidence has gone down since 1993 having declined by 50 percent in all racial/ethnic groups with the exception of Asians. Figure 1: TB infection rates by race/ethnicity groups White 45 40 Black 35 30 Hispanic Rate 25 20 Asian 15 10 5 0 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 1,993.00 Native Hawaiian/Other Pacific Islanders American Natives or Alaska Natives Comparing the TB cases among racial/ethnic groups, Asians TB cases is 26 times that of nonHispanic whites, 8 times that of Blacks, 20 times that of Hispanic Native Hawaiians, and 7 times that of Hispanics. THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES 5 Foreign- born persons The 2011 data indicate that foreign-born persons accounted for 62 percent of all TB cases. The health report indicates that for the last eleven years foreign-born persons have been contributing the biggest percent of TB burden. This represents a different scenario compared to 1993 statistic that show foreign-born persons contributing less than 30 percent of annual TB cases. Although the overall TB cases have declined since 1993, the rate has been less substantial among foreign-born persons. The 2011 data show that foreign-born persons were 11.5 times more likely to get infected that the U.S-born persons. The 2011 TB prevalence rate among the U.S-born and foreign-born persons stood at 1.5 and 17.2 per 100,000 respectively. Among the foreign-born persons, the Asians and Hispanic accounts fro 80 percent of the foreign-born TB cases. The numbers of cases among the foreign-born persons according to countries of origin include Mexico (1,432), India (502), China (376), Philippines (757), Haiti (187), Vietnam (546), and Guatemala (166). TB rates among immigrant communities are high because the countries of origin lack adequate screening and tuberculosis prevention therapy (Walter et al., 2014). TB prevalence rates by state The 2011 data show a continued decline in TB case rates in 29 states and an increase in 16 states including the District of Columbia. The rates of TB cases in 38 states were below the United States’ national average of 3.4 per 100,000. However, the rate of TB cases in twelve states and the District of Columbia was above 3.4 per 100,000. The states of California, New York, Texas, and Florida each reported 500 TB cases or more according to 2011 data. The data also indicate that over 50 percent of TB cases were in the foreign-born persons in 32 states. In addition, foreign-born population accounted for 70 percent of reported cases of TB in seventeen THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES 6 states. Foreign-born population account for 100% of TB cases reported in North Dakota, 85% and 84% in Minnesota and Massachusetts respectively. The highest percent of TB case rates among the U.S-born persons occurred in the states of Mississippi and Montana at 80% and 88% respectively(Lim et al., 2013). Risk factors According to Van Sighem et al. (2015), an HIV/AIDS infection is a major risk factor for the development of Tuberculosis. The human immunodeficiency virus diminishes the body’s ability to resist infection, thus increasing the likelihood of getting TB infection. HIV weakens a person’s immune system and thus increases chances of developing TB. World Health organization data indicate that TB account for 23 percent of HIV/AIDS deaths worldwide. For those individuals infected with TB, the rate of developing active TB among the HIV-positive patient is 30 times that of the HIV-negative people. Data shows that 1.1 million HIV-positive people globally developed TB in 2011, this represent 13 percent of all TB cases. HIV has been identified an important determinant of the rising incidence of TB among poor populations. The 2011 data indicate that 6 percent of all TB cases in the United States were HIV-related; the rate was even higher (10.0 %) among 25-44 year olds (Suthar et al., 2012). Behavioral risk factors Studies show people who smoke tobacco and those who consume alcohol are at a higher risk of developing active TB on exposure than non-tobacco smoker and non-alcohol consumers. Studies associate cigarette smoking to increased rate of TB infection. According the studies, cigarette smokers have a higher risk of TB infection and developing active TB than nonsmokers THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES 7 do. Marginalized populations, such as homeless and prisoners exposed to injection drug abuse have a higher chance of getting TB infection (Basu et al., 2011). Occupational risk factors According to Lim et al. (2013), scientific studies show that proximity to infectious TB case increases the risk of becoming infected with TB Mycobacterium and developing active TB. Studies show that people in close contact with TB cases such as health care workers, caregiver, and household contact are at higher risk of TB infection. Slow socioeconomic status Studies have shown that rapid urbanization and social economic status (SES) influence an individual’s susceptibility to TB infection. Studies show that people with low SES have a higher risk of TB infection because they are exposed to other TB risk factors such as alcoholism, indoor air pollution, and malnutrition. A person with low SES are also exposed to poor ventilation, crowded housing area, and unsafe cooking facilities (Glaziou et al., 2013). Malnutrition Malnutrition both at macro- and micro-deficiency is an important risk factor because it impairs human immune response, thus increasing the risk of developing active TB. According to studies, malnourished children have twice the chances of developing TB disease than wellnourished children. In addition, malnourished adults have six to ten times chances of developing active TB than well-nourished adults (Cegielski, Arab & Cornoni, 2012). Diabetes THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES 8 Studies have shown that diabetes also increases the risk of developing active TB. Studies also show diabetes patients have three times chances of developing TB than people without diabetes. Diabetes also increases the risk of TB death by 1.89 times and five times if a patient suffers from diabetes mellitus. Conclusion Since 1979, TB death rates have been on a downward trend except 1985-1992 periods during the advent of HIV/AIDS. The number of reported TB cases in the United States has continuously reduced since 1993 and by 2011, the rate of TB infection stood at 3.4 per 100,000 persons. The TB burden in America is not as bad as in the other regions in the world; however, TB is serious health problem the federal government has made an effort to address. Many factors contribute to increased TB incident in U.S, they include HIV/AIDS, behavioral factors (alcoholism and tobacco use), immigrants’ issues, social economic status, and occupational factors. Eliminating TB infection in the United States will require a concerted effort in prevention, diagnosis, treatment, and complete reporting. THE SIGNIFICANCE OF TUBERCULOSIS IN THE UNITED STATES 9 References Basu, S., Stuckler, D., Bitton, A., & Glantz, S. A. (2011). Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis. Bmj, 343, d5506. Cegielski, J. P., Arab, L., & Cornoni-Huntley, J. (2012). Nutritional risk factors for tuberculosis among adults in the United States, 1971–1992. American journal of epidemiology, kws007. Glaziou, P., Falzon, D., Floyd, K., & Raviglione, M. (2013). Global epidemiology of tuberculosis. Semin Respir Crit Care Med, 34(1), 3-16. Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., ... & Aryee, M. (2013). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet, 380(9859), 2224-2260. Suthar, A. B., Lawn, S. D., Del Amo, J., Getahun, H., Dye, C., Sculier, D., ... & Granich, R. M. (2012). Antiretroviral therapy for prevention of tuberculosis in adults with HIV: a systematic review and meta-analysis. PLoS Med, 9(7), e1001270. van Sighem, A., Nakagawa, F., De Angelis, D., Quinten, C., Bezemer, D., de Coul, E. O., ... & Phillips, A. (2015). Estimating HIV incidence, time to diagnosis, and the undiagnosed HIV epidemic using routine surveillance data. Epidemiology (Cambridge, Mass.), 26(5), 653. Walter, N. D., Painter, J., Parker, M., Lowenthal, P., Flood, J., Fu, Y., ... & Reves, R. (2014). Persistent latent tuberculosis reactivation risk in United States immigrants. American journal of respiratory and critical care medicine, 189(1), 88-95. COH 315: Epidemiology Paper Rubric Students are expected to submit a 5 paged research papers of choice. The paper will focus on either a chronic non-communicable disease or a communicable disease that is of great significance in the United States. The paper will focus on the burden of disease/distribution, prevalence and risk factors. Each paper should reflect the application of knowledge and skill, and source credibility. The content encompasses the expression of authenticity with validity and reliability. Scholarly sources are expected to be used and appropriately cited. PLO: #1. Explain the core principles of public health and their relationship to the health status of groups, communities, and populations at the local, state, national, and international levels. Significance Burden of Disease/ Distribution and Prevalence Identifies Risk Factors Outstanding Achievement 20% Student has chosen a disease of great significance in the United States and has presented evidence of high prevalence, high incidence, many years of potential life lost or an epidemic 20% Clear explanation of the prevalence, incidence and distribution of the disease by gender, age, ethnicity, income and other important variables Commendable Achievement 15% Student has chosen a disease of great significance however has not supported that claim with evidence Marginal Achievement Failing 10% Students has chosen a disease that is somewhat significant in the United States Unsatisfactory Achievement 5% Student has chosen a disease of minor significance to the United States 15% Explanation of prevalence and incidence without distribution of disease 10% Identifies only one measure of disease burden 5% Lack of clear explanation of the data being presented 0% Missing 25% Includes behavioral, occupational and environmental risk 18.75% Correctly identifies multiple risk factors from one reliable 12.5% Identifies limited risk factors 6.25% Incorrectly identifies risk factors 0% Missing 0% Student has not focused the presentation on a disease Use of primary and secondary data Writing Style factors. Correctly identifies risk factors. Relies on multiple credible sources. source. 10% Correctly identifies and uses primary and secondary data for assessment of the disease. 20% All sentences are wellconstructed with varied structure. All sentences sound natural and are easyon-the-ear when read aloud. Each sentence is clear and has an obvious emphasis. Writer makes no errors in grammar or spelling that distract the reader from the content. Writer makes no errors in capitalization or punctuation, so the paper is exceptionally easy to read. Writer uses vivid words and phrases that linger or draw pictures in the reader's mind, and the choice and placement of the words seems accurate, natural and not forced. 7.5% Correctly identifies data however uses secondary data only for the assessment 5% Limited identification and use of primary and/or secondary data 2.5% Incorrectly identifies primary and secondary data 0% Missing 15% Most sentences are well-constructed with varied structure. Almost all sentences sound natural and are easy-on-the-ear when read aloud, but 1 or 2 are stiff and awkward or difficult to understand. Writer makes few errors in grammar or spelling that distract the reader from the content. Writer makes 1 or 2 errors in capitalization or punctuation, but the paper is still easy to read. Writer uses vivid words and phrases that linger or draw pictures in the reader's mind, but occasionally the words are used inaccurately or 10% Most sentences are well-constructed but have a similar structure. Most sentences sound natural and are easyon-the-ear when read aloud, but several are stiff and awkward or are difficult to understand. Writer makes some errors in grammar or spelling that distract the reader from the content. Writer makes a few errors in capitalization and/or punctuation that catch the reader's attention and interrupt the flow. Writer uses words that communicate clearly, but the writing lacks variety, punch or flair. 5% Sentences lack structure and appear incomplete or rambling. The sentences are difficult to read aloud because they sound awkward, are distractingly repetitive, or are difficult to understand. Writer makes many errors in grammar or spelling that distract the reader from the content. Writer makes several errors in capitalization and/or punctuation that catch the reader's attention and greatly interrupt the flow. Writer uses a limited vocabulary that does not communicate strongly or capture the reader's interest. Jargon 0% seem overdone. Referencing 5% Citations and references are in proper APA format. Ample sources are cited. All claims are supported with a professional reference. 4% Citations and references are in proper APA format. Ample sources are cited. Some claims leave the reader looking for a reference. or cliches may be present and detract from the meaning. 3% Citations and references are in proper APA format. Ample sources are cited. Many claims leave the reader looking for a reference. 2% Citations and references are limited, missing or incorrect. 0% Citations and references are missing or incorrect. ...
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Final Answer




HIV Epidemiology



HIV Epidemiology
HIV cases were first reported in early 1980 and have, over the years, grown to infect
more than 70 million people as of 2018, according to the UN. The global pandemic has played a
significant role in influencing a considerable change in the lifestyles of people in a bid to reduce
its spread. HIV, which is an acronym for the human immunodeficiency virus, attacks the body's
T cells, which are responsible for fighting the body's infection (Fettig et al., 2014). Once the
virus has destroyed the cells, it causes the disease of AIDS. The disease poses a significant
public health risk due to the high cost that comes with controlling the spread of infections. With
the HIV being a global epidemic, the world has achieved considerable stride in the fight against
this disease, and this has resulted in a drop in new infections, as well as increased survival rates.
According to the World Health Organization (WHO), there are about 75 million people in
the world who have been infected with the virus since the beginning of the outbreak (WHO,
2020). Of the 75 million, 32 million have died of HIV related complications, whereas more than
37 million are currently living with HIV (WHO, 2020). The geographical distribution of the
virus varies from one region to another, with some areas around the world carrying the most
burden while others are carrying a small burden. According to WHO, Subsaharan Africa remains
to the area that takes the most substantial weight of HIV infected people, with statistics showing
that the region accounts for about 33% of the people living with HIV (WHO, 2020). 61% of new
infections also occurred in this region. Other areas with high rates of infections include Asia,
South America, and the Caribbean (Fettig et al., 2014).
Incidence and Distribution in the US



As of 2016, there were 1.1 million cases of HIV in the United States, with the distribution
varying among a diverse group of the population (Fauci et al., 2019). According to the CDC,
69% of all US HIV cases were among the LGBTQ community, 24% among heterosex...

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