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Political, Economic, and Health Determinants of Tuberculosis Incidence

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Political, Economic, and Health Determinants of Tuberculosis Incidence University of Central Florida STARS Electronic Theses and Dissertations, 2004-2019 2016 Political, Economic, and Health Determinants of Tuberculosis Incidence Ashley Rutherford University of Central Florida Part of the Health Policy Commons, and the Health Services Administration Commons Find similar works at: https://stars.library.ucf.edu/etd University of Central Florida Libraries http://library.ucf.edu This Doctoral Dissertation (Open Access) is brought to you for free and open access by STARS. It has been accepted for inclusion in Electronic Theses and Dissertations, 2004-2019 by an authorized administrator of STARS. For more information, please contact [email protected]. STARS Citation Rutherford, Ashley, "Political, Economic, and Health Determinants of Tuberculosis Incidence" (2016). Electronic Theses and Dissertations, 2004-2019. 5645. https://stars.library.ucf.edu/etd/5645 POLITICAL, ECONOMIC, AND HEALTH DETERMINANTS OF TUBERCULOSIS INCIDENCE by ASHLEY E RUTHERFORD MPH University of South Carolina, 2013 B.S. Stetson University, 2012 A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Public Affairs in the College of Health and Public Affairs at the University of Central Florida Orlando, Florida Fall Term 2016 Major Professor: Lynn Unruh i © 2016 Ashley E Rutherford ii ABSTRACT The epidemiologic transition has shifted major causes of mortality from infectious disease to chronic disease; however, infectious diseases are again re-emerging as a major global concern (Diamond, 1997; Karlen, 1995; McNeil, 1976). This research aimed to identify potential areas of infectious disease influence that are not health-related in order to help governments and policymakers establish new policies, correct current policies, or further address these issues in order to effectively prevent and combat infectious disease. This study employed a retrospective, cross-sectional, non-experimental design via structural equation modeling (SEM) and examined tuberculosis incidence rates at the country-level. Secondary data from open-source, international databases like World Bank’s World Development Indicators, World Governance Indicators, and World Health Organization for the year 2014 was utilized. Results revealed that the latent constructs of political stability, health system indicators, and detection policies directly affected tuberculosis incidence rates; they also exhibited an indirect effect due to covariation. Economic stability did not direct affect tuberculosis incidence, but it indirectly influenced incidence through the covariation of political stability, health system indicators, and detection policies. As a country’s political stability increased, tuberculosis incidence decreased. As positive health system indicators increased, tuberculosis incidence decreased. Countries with more Xpert detection policies in place experienced an apparent increase in tuberculosis incidence. iii This dissertation is dedicated to my parents, Lynn and Patricia Rutherford, who loved, encouraged, and motivated me during all my education pursuits. This study is also in loving memory of Robert Penn Mobley, my dearest friend, who was called away from us too soon. Your uplifting attitude, joyful laughter, and warm embrace will be forever loved and missed. Hope I made you all proud! iv ACKNOWLEDGMENTS I would like to thank Dr. Lynn Unruh for her words of wisdom, encouragement, and guidance as my committee chair, professor, and research mentor. I would also like to thank Dr. Thomas Wan for his assistance with all things structural equation modeling and for serving as a committee member. Dr. Matthew Nobles, thanks for constantly sporting the flip flops, making football a priority in life, and for serving as a committee member. Dr. Kyle Rohde, thank you for agreeing to serve as an outside committee member. Your tuberculosis expertise and microbiological point of view have greatly informed this research study. I would also like to thank my parents whose lives I unexpectedly interrupted many years ago. Hopefully I have kept you young and made you proud. v TABLE OF CONTENTS LIST OF FIGURES ....................................................................................................................... ix LIST OF TABLES .......................................................................................................................... x LIST OF ACRONYMS AND ABBREVIATIONS ...................................................................... xi CHAPTER ONE: INTRODUCTION ............................................................................................. 1 Background ................................................................................................................................. 1 Purpose ........................................................................................................................................ 3 Study Significance ...................................................................................................................... 5 Research Methods ....................................................................................................................... 6 Research Questions & Hypotheses ............................................................................................. 7 CHAPTER TWO: THEORETICAL FRAMEWORK AND LITERATURE REVIEW ................ 9 Theoretical Framework ............................................................................................................... 9 Infectious Disease as a Health System Indicator .................................................................... 9 Frameworks for Population Health ....................................................................................... 10 Conceptual Model ..................................................................................................................... 13 Literature Review...................................................................................................................... 16 Political Stability ................................................................................................................... 17 Tuberculosis Detection Policies and Their Impact ............................................................... 23 Economic Stability ................................................................................................................ 24 Health System Indicators ...................................................................................................... 28 Control Variables .................................................................................................................. 36 CHAPTER THREE: METHODOLOGY ..................................................................................... 41 Research Questions & Hypotheses ........................................................................................... 41 Research Design........................................................................................................................ 42 Sample Selection ....................................................................................................................... 44 Data Collection ......................................................................................................................... 44 Measures ................................................................................................................................... 46 Data Analysis ............................................................................................................................ 51 Data Imputation .................................................................................................................... 51 Univariate Analyses .............................................................................................................. 51 vi Correlation Analysis ............................................................................................................. 53 Measurement Model Analysis .............................................................................................. 55 Structural Equation Model .................................................................................................... 58 CHAPTER FOUR: FINDINGS .................................................................................................... 60 Descriptive Statistics ................................................................................................................. 60 Measurement Model Analysis: Confirmatory Factor Analysis ................................................ 61 Political Stability Measurement Model ................................................................................ 62 Economic Stability Measurement Model.............................................................................. 64 Health System Indicators Measurement Model .................................................................... 65 Detection Policies Measurement Model ............................................................................... 67 Measurement Model Analysis: Covariance Model................................................................... 69 Reliability Analysis ................................................................................................................... 72 Final Structural Equation Model ..............................................................................................
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