Prognostic value of an abnormal chest X-ray result in predicting the development of tuberculosis

Although tuberculosis is preventable, whom to prioritize for preventive interventions is debated. As part of a follow-up to a mass tuberculosis screening, we aimed to evaluate tuberculosis incidence among persons with distinct baseline X-ray results. From March to October 2020, we implemented a mass tuberculosis screening intervention among elderly persons in eastern China. Participants were followed for incident tuberculosis until October 2022. Tuberculosis incidence over two years among participants with differing baseline chest X-ray results were assessed. Physical examinations and X-rays were administered to all participants. Among persons suspected of tuberculosis, computed tomography, culture or GeneXpert MTB/RIF was performed. Among 183,808 participants, 27,796 had a baseline abnormal X-ray. The annualized incidence per 100,000 person-years was 1,525 (95% CI, 989-2,243), 278 (202-373), 325 (218-466), and 61 (50-75) among participants with X-rays suggestive of active, stable, uncertain and normal, respectively. Among persons with X-ray findings suggestive of tuberculosis, the increased hazard was 16.7 (95% CI, 11.9-23.4). These results demonstrate the risk of developing tuberculosis among persons with an abnormal chest X-ray was very high. Combining mass screening with preventive interventions based on X-ray findings should be explored as a combination intervention package to reduce tuberculosis in high-risk populations.