Extrapulmonary tuberculosis among foreign-born patients, New York City, 1995 to 1996

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Tuberculosis (TB) cases in New York City show increasing trends in both extrapulmonary disease and foreign-born populations since 1992.
• Extrapulmonary TB presents diagnostic challenges and can occur in various body sites beyond the lungs.

Purpose of the Study:

• To investigate the association between region of birth and the site of extrapulmonary tuberculosis.
• To identify specific foreign-born groups with a higher likelihood of extrapulmonary TB.

Main Methods:

• Analysis of 3982 confirmed tuberculosis cases from 1995-1996 in New York City.
• Statistical control for demographic (age, gender) and clinical factors (culture result, reporting facility, HIV status).
• Comparison of extrapulmonary TB rates among patients born in different global regions versus those born in the United States.

Main Results:

• Patients from the Middle East, India, other Asian countries, sub-Saharan Africa, and the Caribbean demonstrated significantly higher odds of extrapulmonary TB compared to US-born patients.
• Odds ratios ranged from 2.0 to 3.9 for these groups, with p-values < .0001.
• A rising proportion of foreign-born individuals in TB cases correlates with an increased likelihood of extrapulmonary involvement.

Conclusions:

• Region of birth is a significant factor associated with the site of tuberculosis disease.
• Healthcare providers should maintain a high index of suspicion for extrapulmonary TB in foreign-born individuals from specific high-risk regions.
• Further research is needed to understand the underlying reasons for these observed regional differences in TB disease presentation.