Increased prevalence of advanced tuberculosis in rural low tuberculosis caseload counties in North Carolina

SETTING: Pulmonary tuberculosis (TB) patients reported in North Carolina (NC), USA, from 1996 to 2008 (inclusive). OBJECTIVE: To compare prevalence of cavitary TB as a surrogate marker for advanced disease in low-caseload counties with high-caseload counties. DESIGN: A multivariate log binomial regr...

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Bibliographic Details
Published in:	The international journal of tuberculosis and lung disease Vol. 15; no. 11; pp. 1455 - 1461
Main Authors:	GUDERIAN, L. J, MILLER, W. C, SENA, A. C, STOUT, J. E
Format:	Journal Article
Language:	English
Published:	Paris International Union Against Tuberculosis and Lung Disease 01-11-2011 International Union against Tuberculosis and Lung Disease
Subjects:	Adolescent Adult Advanced Tuberculosis Aged Aged, 80 and over Bacterial diseases Biological and medical sciences Early Diagnosis Epidemiology Female Human bacterial diseases Humans Infectious diseases Male Medical sciences Middle Aged Mycobacterium North Carolina - epidemiology Pneumology Predictive Value of Tests Prevalence Regression Analysis Respiratory system : syndromes and miscellaneous diseases Risk Assessment Risk Factors Rural Rural Health - statistics & numerical data Time Factors Tuberculosis - diagnosis Tuberculosis - epidemiology Tuberculosis and atypical mycobacterial infections Young Adult North Carolina United States North America America USA, North Carolina Infection Prevalence Tuberculosis Low Respiratory disease rural Bacteriosis Rural area Mycobacterial infection advanced tuberculosis Epidemiology Pneumology
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Summary:	SETTING: Pulmonary tuberculosis (TB) patients reported in North Carolina (NC), USA, from 1996 to 2008 (inclusive). OBJECTIVE: To compare prevalence of cavitary TB as a surrogate marker for advanced disease in low-caseload counties with high-caseload counties. DESIGN: A multivariate log binomial regression model was used to estimate prevalence ratios (PRs) for cavitary TB. RESULTS: The proportion of TB cases in low-caseload counties vs. the total number of TB cases in NC over the study period increased from 10% in 1996 to 20% in 2008. After adjusting for human immunodeficiency virus (HIV) status, excess alcohol use and report year, patients in rural areas of low-caseload counties had greater prev- alence (PR 1.40, 95%CI 1.19-1.64) of cavitary disease compared with patients from rural areas of high-caseload counties. The prevalence of cavitary TB did not differ between urban residents of high- or low-caseload counties (PR 1.00, 95%CI 0.86-1.16) after adjusting for HIV status, excess alcohol use and report year. DISCUSSION: TB patients in rural areas of low-caseload counties presented with more advanced TB disease compared with patients from urban and/or high-caseload counties. Barriers to timely recognition of TB in rural low-caseload settings must be considered in TB control programs.
Bibliography:	(R) Medicine - General 1027-3719(20111101)15:11L.1455;1- ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1027-3719 1815-7920
DOI:	10.5588/ijtld.11.0103