Differences in Clinical Presentation among Persons with Pulmonary Tuberculosis: A Comparison of Documented and Undocumented Foreign-Born versus US-Born Persons
Differences in Clinical Presentation among Persons with Pulmonary Tuberculosis: A Comparison of Documented and Undocumented Foreign-Born versus US-Born Persons
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DOI：
10.1086/592572
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发表时间：
2008-11-15
影响因子：
11.8
通讯作者：
Holzman, Robert S.
中科院分区：
文献类型：
--
作者：
Achkar, Jacqueline M.;Sherpa, Tsering;Holzman, Robert S.
背景。在美国，大多数结核病 (TB) 病例都是在外国出生的人中诊断出来的，无证外国出生的人在及时获得医疗保健服务方面可能面临特殊障碍。本研究调查肺结核患者临床表现的差异是否与外国出生或证件状况有关。方法。在这项横断面研究中，我们回顾了 1999 年 4 月至 2005 年 3 月期间在纽约市公立医院接受微生物学证实的肺结核诊断的患者的医疗记录。在就诊时对三组肺结核患者（美国出生的人、有证件的外国出生的人和无证件的外国出生的人）进行了定义和比较。使用逻辑回归估计每组入院前症状持续时间 >= 8 周的优势比 (OR)。结果。在 194 名新诊断肺结核患者中，61 名（31%）在美国出生，62 名（32%）在国外出生，71 名（37%）在国外出生，无证件。与美国出生的人相比，外国出生的无证人员咳嗽 (P = .020) 和咯血 (P = .012) 的频率明显更高，并且症状的中位持续时间明显更长（8 周与 4 周；P = .023）。没有观察到有记录的外国出生者和美国出生者之间存在统计学上的显着差异。多变量分析显示，无证身份（与美国出生相比；调整后 OR，4.1；95% 置信区间，1.7-10.2；P = .002）和失业（调整后 OR，2.2；95% CI，1.1-4.5；P = .023）与症状持续时间延长（即 >= 8 周）独立相关。结论。未记录的状态与咳嗽和咯血频率增加以及肺结核医学评估前症状持续时间较长有关。减少外国出生的无证人士获得卫生服务的障碍是否可以加强结核病控制值得进一步研究。
Background. Most cases of tuberculosis (TB) in the United States are diagnosed in foreign-born persons, and undocumented foreign-born persons may face particular barriers to timely access to health care services. This study investigates whether differences in clinical presentations among persons with pulmonary TB are associated with foreign birth or documentation status.Methods. In this cross-sectional study, we reviewed the medical records of patients who had received a diagnosis of microbiologically proven pulmonary TB at a New York City public hospital during the period April 1999 through March 2005. Three groups of patients with pulmonary TB (US-born persons, foreign-born persons with documents, and undocumented, foreign-born persons) were defined and compared at presentation. Odds ratios (ORs)for a symptom duration >= 8 weeks before hospital admission for each group were estimated using logistic regression.Results. Among 194 subjects with newly diagnosed pulmonary TB, 61 (31%) were US born, 62 (32%) were documented foreign-born persons, and 71 (37%) were undocumented foreign-born persons. Undocumented foreign-born persons presented with significantly higher frequencies of cough (P = .020) and hemoptysis (P = .012) and had a significantly longer median duration of symptoms, compared with US-born persons (8 vs. 4 weeks; P = .023). No statistically significant differences between documented foreign-born and US-born persons were observed. Multivariate analysis revealed that undocumented status (compared with being US born; adjusted OR, 4.1; 95% confidence interval, 1.7-10.2; P = .002) and being unemployed (adjusted OR, 2.2; 95% CI, 1.1-4.5; P = .023) were independently associated with a prolonged symptom duration (i.e., >= 8 weeks).Conclusions. Undocumented status was associated with an increased frequency of cough and hemoptysis and a longer duration of symptoms before medical evaluation for pulmonary TB. Whether reducing barriers to health services for undocumented foreign-born persons could enhance TB control deserves additional study.