Infectious Disease

The region of birth can predict the time to be diagnosed with TB in foreign-born people in the United States

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Researchers found a link between region of birth and time to diagnosis in foreign-born people in the United States with tuberculosis, suggesting that a person’s place of birth could predict the progression from latent TB to TB.

Previous research has shown that around 70% of cases of TB in the US occur in people who were not born in the US and that more than 85% of cases of TB in the US occur in people who were not born in the US occur as latent TB progresses to TB.

TB infographic

Source: Talwar A, et al. Emerging Infect Dis. 2021; doi: 10.3201 / eid2706.203663.

“The CDC recommends that efforts to eradicate tuberculosis in the US focus in part on identifying and treating latent tuberculosis infections in non-US-born individuals.” Amish Talwar, MD, MPH, a medical officer for the CDC, said Healio. Understanding the region of birth as a prognostic indicator and other factors associated with the progression of latent TB infection to TB disease can help health officials focus TB prevention resources on non-US-born individuals with latent TB -Support infection who are most at risk of developing TB disease. “

Talwar and colleagues used national TB surveillance data to look at a person’s time from entering the US to being diagnosed with TB in non-US-born individuals who contracted TB between 2011 and 2018. They excluded people with TB that was due to the recent transmission and instead focused on it in people whose TB was likely caused by the progression of latent TB that was acquired in their country of birth.

They found that 46.6% of TB cases in non-US born people were diagnosed 10 years or more after arriving in the US. The median time to diagnosis was lowest in people from Central Africa (26 months) and highest in people from the West in Europe (524 months). A total of 128 months for men (95% CI, 116-146) and 121 months for women (95% CI, 108-136).

Talwar said the limitations of the study included that the characteristics of US immigrants may not be representative of those staying in their country of birth, an inability to emigrate the number of non-US born people, an inability to determine the reason for explain immigration and the inability to categorize the individual countries analyzed.

Other limitations included the potential for misclassification of patients whose TB disease was excluded due to recent TB transmission, the inability to assess the impact of HIV status and diabetes on the date of TB diagnosis, and the Study that did not include the population of non-Americans – those born who did not develop TB during the course of the study.

“Additional studies using data sources that contain information about risk factors such as HIV infection and diabetes mellitus would be helpful in determining the potential impact of these comorbid conditions on the progression of latent TB infection into TB disease,” Talwar said. “Such studies would also benefit from considering TB rates in countries of birth, if this is feasible. Similar studies in countries with health systems comparable to the United States and different populations would also help determine whether these results are reproducible and could elucidate the causes of regional differences in the time to diagnosis of TB. “

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