International Journal of Tuberculosis and Lung Disease
Volume 22, Issue 1, 2018, Pages 73-79

Increased tuberculosis risk among immigrants arriving in California with abnormal domestic chest radiographs (Article)

Wong J. , Lowenthal P. , Flood J. , Watt J. , Barry P.M.*
  • a Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, United States, Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, United States
  • b Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, United States
  • c Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, United States
  • d Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, United States
  • e Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, United States

Abstract

Setting: Tuberculosis (TB) cases in California, USA, occur predominantly among foreign-born persons, many of whom have abnormal chest radiographs (CXRs) on overseas medical examination. These persons are recommended for follow-up TB evaluation upon arrival in the United States. Objective: To estimate the increased TB risk associated with abnormal vs. normal domestic CXRs among individuals arriving with abnormal overseas CXRs. Design: Cox regression analyses of 35 633 foreignborn persons aged ≥ 15 years who arrived in California during 1999-2012 with abnormal overseas CXRs and were free of imported active TB. Domestic CXRs were conducted during post-arrival evaluation. Subsequent cases through 2014 were identified from California's TB registry. Rwsults: A total of 121 (0.3%) arrivers developed TB disease. Progression rates were respectively 63.6 (95%CI 50.8-76.4) and 25.4 (95% CI 15.7-35.2) cases/100 000 person-years among persons with abnormal and normal domestic CXRs. Relative to arrivers with normal domestic CXRs, those with abnormal domestic CXRs had an elevated disease risk during the first 4 years after immigration; this increased risk was greatest during the first year (hazard ratio 2.9, 95%CI 1.8-4.8). Conclusion: Among arrivers with abnormal overseas CXRs, those with abnormal CXRs upon domestic evaluation have an elevated disease risk and represent an important target group for preventive treatment. © 2018 The Union.

Author Keywords

Inactive TB TB prevention and control Immigration TB screening

Index Keywords

disease classification immigrant proportional hazards model Registries Proportional Hazards Models mass screening register human risk assessment middle aged priority journal Aged ethnology procedures disease course Young Adult diagnostic imaging Humans migrant Adolescent California male disease registry Emigrants and Immigrants female tuberculosis Article Retrospective Studies major clinical study adult disease exacerbation thorax radiography cohort analysis Disease Progression retrospective study Radiography, Thoracic
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85039075283&doi=10.5588%2fijtld.17.0340&partnerID=40&md5=3117ae2784430ffcd84b637ccb836ae1
DOI: 10.5588/ijtld.17.0340
ISSN: 10273719
Cited by: 2
Original Language: English