Long-term risk of tuberculosis among foreign-born persons in the United States
Long-term risk of tuberculosis among foreign-born persons in the United States
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DOI：
10.1001/jama.278.4.304
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发表时间：
1997-07-23
影响因子：
120.7
通讯作者：
Castro, KG
中科院分区：
文献类型：
--
作者：
Zuber, PLF;McKenna, MT;Castro, KG
背景。美国结核病（TB）病例已连续4年下降，但外国出生的人中的病例数量正在增加。描述外国出生的人在美国居住时间长短方面的结核病风险。国家监测数据的横截面分析。美国病人- 1986年至1994年期间向疾病控制和预防中心报告的所有经证实的结核病例。按年龄、出生地、居住时间、抵达美国时的年龄或这些变量的组合列出的结核病特定层发病率。来自结核病高流行率国家的几组人在抵达后20多年的发病率高于每10万人年20人。在长期居民中，那些在五岁以后到达美国的人的结核病发病率比五岁以前到达的同龄人高2至6倍。总共有45%的结核病病例是在35岁以下的人中，另外18%是在35岁之前到达美国的人。输入性结核分枝杆菌感染（活动性或潜伏性）是美国外国出生者中大多数结核病病例的原因。在这些人群中，检测最近抵达的活动性病例是主要优先事项，但许多病例发生在35岁之前抵达美国的人中，这可能通过预防性治疗得以避免。如果不加大努力解决结核病的全球负担，使用现有的诊断和治疗方式在美国消除结核病可能是不可行的。
Context.-Cases of tuberculosis (TB) in the United States have declined for 4 consecutive years, but cases among foreign-born persons account for an increasing percentage.Objective.-To describe the risk of tuberculosis among foreign-born persons with respect to their length of residence in the United States.Design.-Cross-sectional analysis of national surveillance data.Setting.-The United States.Patients.-All verified TB cases reported to the Centers for Disease Control and Prevention between 1986 and 1994.Main Outcome Measure.-Stratum-specific incidence rates of TB by age, place of birth, length of residence, age at arrival in the United States, or combinations of these variables.Results.-Several groups of persons from countries with a high prevalence of TB had incidence rates higher than 20 per 100 000 person-years more than 20 years after arrival. Among long-term residents, those who arrived in the United Stales after their fifth birthday had incidence rates of TB 2 to 6 times higher than those of similar age who arrived before their fifth birthday. A total of 45% of the TB cases were among persons younger than 35 years and an additional 18% were among persons who arrived in the United States before their 35th birthday.Conclusions.-Imported Mycobacterium tuberculosis infection (active or latent) is responsible for most TB cases among foreign-born persons in the United States. Detection of active cases among recent arrivals is the main priority in these populations, but many cases were in persons who arrived in the United States before the age of 35 years that could potentially have been avoided with preventive therapy. Elimination of TB in the United States may not be feasible using available diagnostic and treatment modalities without increased efforts to address the global burden of this disease.