Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factors
Background: Advanced pulmonary tuberculosis (APT) may reflect delays in tuberculosis (TB) diagnosis and contribute to ongoing disease transmission and poor outcomes. We characterized trends and factors associated with APT over ten years in a high TB-burden county within the United States. Methods: W...
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Elsevier
2024-12-01
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| Series: | Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405579424000627 |
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| author | Rachel Marusinec Tessa Clifton Amit S. Chitnis Devan Jaganath |
| author_facet | Rachel Marusinec Tessa Clifton Amit S. Chitnis Devan Jaganath |
| author_sort | Rachel Marusinec |
| collection | DOAJ |
| description | Background: Advanced pulmonary tuberculosis (APT) may reflect delays in tuberculosis (TB) diagnosis and contribute to ongoing disease transmission and poor outcomes. We characterized trends and factors associated with APT over ten years in a high TB-burden county within the United States. Methods: We evaluated microbiologically and clinically confirmed TB cases reported to the Alameda County Public Health Department during 2010–2019. APT was defined as the presence of cavitation on chest imaging and positive acid-fast bacilli sputum smear. Over the ten-year period, we determined overall incidence and annual trends, and conducted multivariable logistic regression to identify sociodemographic and clinical factors associated with APT. Results: We included 997 cases with pulmonary TB, of which 128 (12.8 %) had APT. The 10-year incidence of APT was 8.8 cases per 100,000, with no significant change in proportion over time. The median age of cases with APT were 50 years (IQR 32–61), 68 % were male, and 78.9 % were non-US-born. On multivariable assessment, APT cases were more likely than non-APT cases to use drugs in the past year (aOR 2.43, 95 % CI 1.10–35.09), to have diabetes (aOR 2.51, 95 % CI: 1.59–3.96), and be HIV negative (aOR 9.32 versus HIV positive, 95 % CI 1.87–169.77). While US nativity was not significantly associated with APT, it was an effect modifier. In stratified analysis, APT was more likely among those with drug-use in the last year among US-born, while diabetes was associated with APT among non-US-born individuals. Conclusions: APT remains a substantial proportion of TB cases. Efforts to increase awareness and access to care are needed for key risk groups including those with recent drug use or diabetes, with consideration of cultural and linguistic factors given differences by US nativity. |
| format | Article |
| id | doaj-art-329ee6e88645456ba94b0202e6fb34a2 |
| institution | Kabale University |
| issn | 2405-5794 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
| spelling | doaj-art-329ee6e88645456ba94b0202e6fb34a22024-12-12T05:22:07ZengElsevierJournal of Clinical Tuberculosis and Other Mycobacterial Diseases2405-57942024-12-0137100475Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factorsRachel Marusinec0Tessa Clifton1Amit S. Chitnis2Devan Jaganath3Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Health, Public Health Department, 1100 San Leandro Blvd, San Leandro, CA 94577, USASchool of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA 94704, USATuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Health, Public Health Department, 1100 San Leandro Blvd, San Leandro, CA 94577, USADivision of Pediatric Infectious Diseases, University of California, San Francisco, 550 16th St., 4th Floor, San Francisco, CA 94158, USA; Center for Tuberculosis, University of California, San Francisco, 550 16th St., 3rd Floor, San Francisco, CA 94158, USA; Corresponding author at: University of California, San Francisco, 550 16th St., 4th Floor, San Francisco, CA 94158, USA.Background: Advanced pulmonary tuberculosis (APT) may reflect delays in tuberculosis (TB) diagnosis and contribute to ongoing disease transmission and poor outcomes. We characterized trends and factors associated with APT over ten years in a high TB-burden county within the United States. Methods: We evaluated microbiologically and clinically confirmed TB cases reported to the Alameda County Public Health Department during 2010–2019. APT was defined as the presence of cavitation on chest imaging and positive acid-fast bacilli sputum smear. Over the ten-year period, we determined overall incidence and annual trends, and conducted multivariable logistic regression to identify sociodemographic and clinical factors associated with APT. Results: We included 997 cases with pulmonary TB, of which 128 (12.8 %) had APT. The 10-year incidence of APT was 8.8 cases per 100,000, with no significant change in proportion over time. The median age of cases with APT were 50 years (IQR 32–61), 68 % were male, and 78.9 % were non-US-born. On multivariable assessment, APT cases were more likely than non-APT cases to use drugs in the past year (aOR 2.43, 95 % CI 1.10–35.09), to have diabetes (aOR 2.51, 95 % CI: 1.59–3.96), and be HIV negative (aOR 9.32 versus HIV positive, 95 % CI 1.87–169.77). While US nativity was not significantly associated with APT, it was an effect modifier. In stratified analysis, APT was more likely among those with drug-use in the last year among US-born, while diabetes was associated with APT among non-US-born individuals. Conclusions: APT remains a substantial proportion of TB cases. Efforts to increase awareness and access to care are needed for key risk groups including those with recent drug use or diabetes, with consideration of cultural and linguistic factors given differences by US nativity.http://www.sciencedirect.com/science/article/pii/S2405579424000627TuberculosisEpidemiologySurveillanceUnited StatesDelayed diagnosis |
| spellingShingle | Rachel Marusinec Tessa Clifton Amit S. Chitnis Devan Jaganath Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factors Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Tuberculosis Epidemiology Surveillance United States Delayed diagnosis |
| title | Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factors |
| title_full | Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factors |
| title_fullStr | Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factors |
| title_full_unstemmed | Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factors |
| title_short | Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factors |
| title_sort | advanced pulmonary tuberculosis in alameda county ten year incidence and risk factors |
| topic | Tuberculosis Epidemiology Surveillance United States Delayed diagnosis |
| url | http://www.sciencedirect.com/science/article/pii/S2405579424000627 |
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