Hospitalizations for tuberculosis in New York City: how many could be avoided?

• Published in: The international journal of tuberculosis and lung disease Vol. 14; no. 12; pp. 1603 - 1612
• Main Authors: THOMAS, J. A, LARAQUE, F, MUNSIFF, S, PIATEK, A, HARRIS, T. G
• Format: Journal Article
• Language: English
• Published: Paris International Union against Tuberculosis and Lung Disease 01-12-2010
• Subjects: Adolescent; Adult; African Americans - statistics & numerical data; Aged; Bacterial diseases; Biological and medical sciences; Child; Child, Preschool; Emigrants and Immigrants - statistics & numerical data; Female; Health Services Misuse - statistics & numerical data; Hospitalization - statistics & numerical data; Human bacterial diseases; Human immunodeficiency virus; Humans; Infant; Infectious diseases; Male; Medical sciences; Middle Aged; Multivariate Analysis; Mycobacterium; New York City - epidemiology; Pneumology; Practice Guidelines as Topic; Radiography; Respiratory system : syndromes and miscellaneous diseases; Sputum - microbiology; Substance-Related Disorders - epidemiology; Tuberculosis - diagnostic imaging; Tuberculosis - ethnology; Tuberculosis - therapy; Tuberculosis and atypical mycobacterial infections; Young Adult; New York; United States; North America; America; USA, New York, New York City; Infection; inappropriate hospitalization; Costs; Tuberculosis; cost; Respiratory disease; Health economy; Bacteriosis; Hospitalization; Mycobacterial infection; Public health; Pneumology
• ISSN: 1027-3719; 1815-7920

To determine which factors were associated with hospitalization for tuberculosis (TB) in New York City (NYC), United States, and to estimate the proportion of potentially avoidable admissions.
Patients diagnosed with TB from April to June 2003 were included. Records of hospitalized patients were reviewed to determine whether hospitalization was appropriate. Hospitalization was considered appropriate if patients met ≥1 of the NYC health department hospitalization criteria and/or needed hospitalization per study physicians' judgment. The association of patient characteristics with hospitalization and with having an inappropriate hospitalization was evaluated using multivariate analyses. TB cases from 2008 were also evaluated to determine whether more recent cases had similar associations with hospitalization.
Of 315 patients diagnosed with TB during the study, 226 (72%) were hospitalized. Hospitalized patients were more likely to have a cavitary chest radiograph (adjusted odds ratio [aOR] 8.11, 95%CI 1.82-36.20), abuse alcohol/drugs (aOR 6.53, 95%CI 2.06-20.67), be Black non-Hispanic (aOR 3.05, 95%CI 1.00-9.38), have unknown human immunodeficiency virus status (aOR 2.67, 95%CI 1.24-5.76), and to have been first evaluated by a private medical provider (aOR 2.37, 95%CI 1.11-5.08). Eighty-seven (38%) of the hospitalizations may have been inappropriate; foreign-born (aOR 3.16, 95%CI 1.39-7.14) and acid-fast bacilli sputum smear-positive (aOR 2.49, 95%CI 1.18-5.23) patients were more likely to be hospitalized inappropriately.
Many TB hospitalizations in NYC may be avoidable. Existing guidelines for diagnosing and managing cases as out-patients need to be put into practice.