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

In New York City both the proportion of total tuberculosis cases that are extrapulmonary and the proportion of total tuberculosis cases that are foreign-born have increased since 1992. We examined the association of region of birth and site of extrapulmonary tuberculosis among 3982 persons confirmed to have tuberculosis in 1995 or 1996, while controlling for age, gender, culture result, reporting facility, and HIV status. Patients born in the Middle East (odds ratio; 3.9, p = .0001), India (odds ratio = 2.5, p = .0007), other Asian countries (excluding China, Japan and countries of the former Soviet Union) (odds ratio = 2.7, p = .0001), sub-Saharan Africa (odds ratio = 2.6, p = .0001), and the Caribbean (odds ratio = 2.0, p = .0001) were more likely to have extrapulmonary disease than patients born in the United States. The proportion of total cases with extrapulmonary involvement is likely to increase in areas where the foreign-born comprise a growing proportion of all cases of tuberculosis. Although reasons for regional differences in tuberculosis disease site are not known, these findings should alert health care providers to maintain a high index of suspicion for extrapulmonary tuberculosis among some foreign-born groups.