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. 2018 Jun 1;22(6):628-636.
doi: 10.5588/ijtld.17.0413.

Increasing likelihood of advanced pulmonary tuberculosis at initial diagnosis in a low-incidence US state

Z-H Yang  1 , T Gorden  1 , D-P Liu  2 , L Mukasa  3 , N Patil  4 , J H Bates  3
Affiliations

Increasing likelihood of advanced pulmonary tuberculosis at initial diagnosis in a low-incidence US state

Z-H Yang et al. Int J Tuberc Lung Dis. .

Abstract
in English, French, Undetermined language

Setting: Arkansas, USA.

Objective: To investigate the relationship between an increase in the proportion of cases with advanced disease at first diagnosis and the recently observed slowing of the decline in tuberculosis (TB) incidence in low-incidence US states.

Design: We conducted descriptive statistical analyses of de-identified surveillance data of 1246 culture-confirmed TB patients reported in Arkansas during 1996-2013. We then fitted stepwise, multivariate logistic regression models to identify predictors for advanced disease at diagnosis, defined as having either smear-positive sputum or lung cavitation.

Results: From 1996 to 2013, the proportion of new cases with positive sputum smear and cases with lung cavitation increased from 51.6% to 75% and from 37.7% to 50%, respectively. Patients diagnosed during 2006-2013 were more likely to have positive sputum smears (adjusted odds ratio [aOR] 2.55, 95%CI 1.95-3.35) or lung cavitation (aOR 1.49, 95%CI 1.14-1.95) than those diagnosed during 1996-2005. During 1996-2013, age 15-64 years and excessive alcohol use were predictive of positive sputum smear or lung cavitation.

Conclusion: Measures to reduce the proportion of cases with advanced disease at first diagnosis may be helpful to achieve further decline in TB incidence in low-incidence settings.

CONTEXTE :: Arkansas, Etats-Unis.

OBJECTIF :: Etudier la relation entre une augmentation de la proportion de cas ayant une maladie à un stade avancé lors du premier diagnostic et le ralentissement récemment observé du déclin de l’incidence de la tuberculose (TB) dans les états à faible incidence aux Etats-Unis.

SCHÉMA :: Nous avons réalisé des analyses statistiques descriptives de données de surveillance, rendues anonymes, de 1246 patients tuberculeux confirmés par culture et déclarés dans l’Arkansas entre 1996 et 2013. Nous avons ensuite adapté des modèles de régression logistique multivariée par étapes afin d’identifier les facteurs de prédiction d’avoir une maladie avancée lors du diagnostic, c’est-à-dire soit avoir un frottis de crachats positif, soit avoir des cavernes pulmonaires.

RÉSULTATS :: De 1996 à 2013, la proportion de nouveaux cas avec soit un frottis de crachats positif, soit une caverne pulmonaire, a augmenté de 51,6% à 75% et de 37,7% à 50%, respectivement. Les patients diagnostiqués entre 2006 et 2013 ont été plus susceptibles d’avoir un frottis de crachats positif (OR ajusté [ORa] 2,55; IC95% 1,95–3,35) ou une caverne pulmonaire (ORa 1,49; IC95% 1,14–1,95) que ceux diagnostiqués entre 1996 et 2005. Entre 1996 et 2013, être âgé de 15–64 ans et consommer de l’alcool en excès ont été des facteurs de prédiction de frottis de crachats positif ou de caverne pulmonaire.

CONCLUSION :: Les mesures visant à réduire la proportion de cas ayant une maladie avancée lors du premier diagnostic pourrait contribuer à accélérer le déclin de l’incidence de la TB dans les états à faible incidence.

MARCO DE REFERENCIA:: Arkansas, Estados Unidos.

OBJETIVO:: Investigar la relación entre un aumento en la proporción de casos con estado avanzado de la enfermedad en el momento del primer diagnóstico y el enlentecimiento reciente de la regresión de la tuberculosis (TB) en los estados con baja incidencia en los Estados Unidos.

MÉTODO:: Se llevó a cabo un análisis estadístico descriptivo de los datos de vigilancia anonimizados de 1246 pacientes con diagnóstico de TB confirmada por cultivo notificados en Arkansas de 1996 al 2013. Mediante un ajuste progresivo en modelos multivariantes de regresión logística, se definieron los factores pronósticos de una enfermedad avanzada en el momento del diagnóstico, definida ya sea como una baciloscopia positiva o la presencia de cavernas pulmonares.

RESULTADOS:: De 1996 al 2013, la proporción de casos nuevos con baciloscopia positiva del esputo aumentó del 51,6% al 75% y la de casos con cavernas pulmonares del 37,7% al 50%. Se observó una mayor probabilidad de obtener un resultado positivo de la baciloscopia de esputo (OR 2,55; IC95% 1,95–3,35) o de presentar cavernas pulmonares (OR 1,49; IC95% 1,14–1,95) en los pacientes diagnosticados del 2006 al 2013, que en los pacientes detectados de 1996 al 2005. Entre 1996 y el 2013, los factores pronósticos de una baciloscopia positiva o de cavernas fueron el hecho de pertenecer al grupo de edad de 15–64 años y el consumo excesivo de bebidas alcohólicas.

CONCLUSIÓN:: La adopción de medidas que disminuyan la proporción de casos que acuden a la primera consulta con un estado avanzado de la enfermedad puede contribuir a acelerar la regresión de la TB en los estados con baja incidencia de la enfermedad.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

Figure 1
Figure 1
Comparison of the incidence rates of adult (aged ⩾15 years), culture-confirmed pulmonary TB in Arkansas, USA, during 1996–2013 (Panels A and B: solid line with shaded 95%CI) with incidence rates of sputum smear-positive cases (Panel A: dotted line with vertical bars of 95%CI), smear-negative cases (Panel A: dashed line with vertical bars of 95%CI), cases with lung cavitation (Panel B: dotted line with vertical bars of 95%CI), and cases without lung cavitation (Panel B: dashed line with vertical bars of 95%CI). TB = tuberculosis; CI = confidence interval.
Figure 2
Figure 2
Yearly proportion of cases with advanced disease at first diagnosis among all adult (aged ⩾15 years) culture-confirmed pulmonary tuberculosis cases in Arkansas, USA, during 1996–2013. Panel A: yearly proportion of sputum smear-positive cases (solid line with vertical bars of 95%CI) and the piecewise linear trend of sputum smear-positive cases over time (dashed line); Panel B: yearly proportion of cases with lung cavitation (solid line with vertical bars of 95%CI) and the piecewise linear trend of cases with lung cavitation (dashed line). CI = confidence interval.
See this image and copyright information in PMC

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