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. 2021 Jun;27(6):1645-1653.
doi: 10.3201/eid2706.203663.

Association between Birth Region and Time to Tuberculosis Diagnosis among Non-US-Born Persons in the United States

Amish Talwar, Rongxia Li, Adam J Langer

Association between Birth Region and Time to Tuberculosis Diagnosis among Non-US-Born Persons in the United States

Amish Talwar et al. Emerg Infect Dis. 2021 Jun.

Abstract

Approximately 90% of tuberculosis (TB) cases among non-US-born persons in the United States are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated whether birthplace is associated with time to disease progression among non-US-born persons in whom TB disease developed. We derived a Cox regression model comparing differences in time to TB diagnosis after US entry among 19 birth regions, adjusting for sex, birth year, and age at entry. After adjusting for age at entry and birth year, the median time to TB diagnosis was lowest among persons from Middle Africa, 128 months (95% CI 116-146 months) for male persons and 121 months (95% CI 108-136 months) for female persons. We found time to TB diagnosis among non-US-born persons varied by birth region, which represents a prognostic indicator for progression of latent TB infection to TB disease.

Keywords: Kaplan-Meier estimate; TB; United States; bacteria; emigrants; immigrants; latent tuberculosis; proportional hazards models; respiratory infections; survival analysis; tuberculosis and other mycobacteria.

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Figures

Figure 1
Figure 1
Flowchart of cohort selection process for study evaluating the time to develop TB among non–US-born persons after entering the United States, 2011–2018. NTSS, National Tuberculosis Surveillance System; TB, tuberculosis.
Figure 2
Figure 2
Kaplan-Meier estimate for time to TB disease diagnosis not attributed to recent transmission among non–US-born persons after entering the United States, 2011–2018. Dotted line represents median time for TB disease diagnosis. TB, tuberculosis.
Figure 3
Figure 3
Estimates for time to TB disease diagnosis not attributed to recent transmission among non–US-born persons, stratified by birth region, United States, 2011–2018. A) Kaplan-Meier estimate for all cases; B) Cox regression adjusted time estimates for male patients; C) Cox regression adjusted time estimates for female patients. TB, tuberculosis.
Figure 4
Figure 4
Estimates for time to TB disease diagnosis not attributed to recent transmission for non–US-born persons, stratified by World Health Organization region, United States, 2011–2018. A) Kaplan-Meier estimate for all cases; B) Cox regression adjusted time estimates for male patients; C) Cox regression adjusted time estimates for female patients. TB, tuberculosis.
See this image and copyright information in PMC

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