Assessment of TB Infection-Related Outpatient Clinical Outcomes Across Neighborhood-Level Deprivation Quartiles.

Abstract

Background: Pediatric tuberculosis infection (TBI) disproportionately affects those in complex social situations. Neighborhood characteristics may influence access to care and TBI-related outcomes. We sought to examine links between neighborhood-level socioeconomic deprivation and clinical outcomes.

Methods: In this retrospective cohort study, we identified children with TBI treated at our pediatric infectious diseases clinics between 2012-2023. We geocoded each child's address to identify neighborhood-level material community deprivation index (MCDI) scores. Outcomes included missed clinic visits, missed antibiotic doses, and changes in antibiotic therapy due to adherence concerns. We assessed time between referral and first visit, first and second visits, and first and last visits. Kruskal-Wallis rank sum test and chi-squared tests examined relationships between DI quartile and clinical outcomes. Log-rank testing and Cox proportional hazard regression models evaluated time-to-event analyses.

Results: We identified 150 children with TBI. There were no differences across MCDI quartiles in rates of missed clinic visits, missed antibiotic doses, changed therapy, or therapy completion. Higher deprivation was associated with longer time between referral and first visit (median 12 days for low/moderate-low deprivation quartiles vs. 24 days for high/moderate-high deprivation quartiles, p=0.004). The high/moderate-high deprivation category had a 39% lower hazard of getting to the first clinic visit after referral compared to the low/moderate-low deprivation category (HR 0.61; 95%CI 0.43, 0.85) after adjustment for race, insurance, and language.

Conclusions: Children with TBI from socioeconomically deprived neighborhoods have longer times from referral to first clinical evaluation. Exploring drivers of differences could promote more equitable TBI care.