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. 2014 Jul-Aug;129(4):351-60.
doi: 10.1177/003335491412900410.

Understanding the burden of tuberculosis among American Indians/Alaska Natives in the U.S.: a validation study

Laura Jean Podewils  1 , Emily Alexy  2 , Stephani Jean Driver  2 , James E Cheek  3 , Robert C Holman  4 , Dana Haberling  4 , Meghan Brett  3 , Eugene McCray  5 , John T Redd  6
Affiliations

Understanding the burden of tuberculosis among American Indians/Alaska Natives in the U.S.: a validation study

Laura Jean Podewils et al. Public Health Rep. 2014 Jul-Aug.

Abstract

Objective: We validated cases of active tuberculosis (TB) recorded in the Indian Health Service (IHS) National Patient Information Reporting System (NPIRS) and evaluated the completeness of TB case reporting from IHS facilities to state health departments.

Methods: We reviewed the medical records of American Indian/Alaska Native (AI/AN) patients at IHS health facilities who were classified as having active TB using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes from 2006 to 2009 for clinical and laboratory evidence of TB disease. Individuals were reclassified as having active TB disease; recent latent TB infection (LTBI); past positive tuberculin skin test (TST) only; or as having no evidence of TB, LTBI, or a past positive TST. We compared validated active TB cases with corresponding state records to determine if they were reported.

Results: The study included 596 patients with active TB as per ICD-9-CM codes. Based on chart review, 111 (18.6%) had active TB; 156 (26.2%) had LTBI; 104 (17.4%) had a past positive TST; and 221 (37.1%) had no evidence of TB disease, LTBI, or a past positive TST. Of the 111 confirmed cases of active TB, 89 (80.2%) resided in participating states; 81 of 89 (91.2%) were verified as reported TB cases.

Conclusions: ICD-9-CM codes for active TB disease in the IHS NPIRS do not accurately reflect the burden of TB among AI/ANs. Most confirmed active TB cases in the IHS health system were reported to the state; the national TB surveillance system may accurately represent the burden of TB in the AI/AN population.

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Figures

Figure 1
Figure 1
Flow chart of AI/AN patients with an ICD-9-CM code for active TB disease (010.0–018.9) in the IHS NPIRS database selected for medical chart review: U.S., 2006–2009
Figure 2
Figure 2
Flow chart of verified TB diagnoses based on chart review among selected AI/AN patients at IHS facilities and reporting of chart-verified TB cases to the state health department: U.S., 2006–2009
See this image and copyright information in PMC

References

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    1. Centers for Disease Control and Prevention (US) National Notifiable Diseases Surveillance System (NNDSS): case definitions. [cited 2013 Mar 5]. Available from: URL: http://wwwn.cdc.gov/nndss/script/casedefDefault.aspx.
    1. Indian Health Service (IHS) Indian Health Service: quick look. [cited 2014 Jan 31]. Available from: URL: http://www.ihs.gov/newsroom/factsheets/quicklook.
    1. Indian Health Service (US) Albuquerque (NM): IHS; 2009. Direct/CHS inpatient data: all diseases, fiscal years 1998–2006, National Patient Information Reporting System.
    1. National Center for Health Statistics, Centers for Medicare & Medicaid Services (US) International classification of diseases, ninth revision, clinical modification (ICD-9-CM) [cited 2013 Sep 14]. Available from: URL: http://www.cdc/gov/nchs/icd/icd9cm.htm.