Abstract

This research has demonstrated conflicting findings related to how environmental factors may affect the spread of tuberculosis (TB). A better understanding of this may have implications for health planning given the changing world climate. This study examines environmental factors, specifically elevation and temperature, demographic and income covariates and their association with TB incidence within the Appalachian region. County-wide TB incidence data were collected from the thirteen states within the Appalachian region for the most recent year available, 2017 or 2018, along with data from the American Community Survey for the corresponding year. A correlation analysis was performed followed by multiple negative binomial regression models to find models with the best fit. The analyses identified clusters of incident TB cases distributed throughout the Appalachian region. Hot spots (that is, highly positively autocorrelated geographic locations) utilizing Getis-Ord Gi* were found within the Southern portion of the Appalachian region while clusters utilizing Anselin local Moran’s I were more spread throughout the region. Temperature was found to be significantly associated with TB incidence in all models, but ethnic distribution explained some of the variation. Future research could benefit from replicating this study with longitudinal data to assess how temperature changes over time affect TB incidence.

Key words: tuberculosis, Appalachia, temperature, elevation.