Tuberculosis infection in the United States - National trends over three decades
Tuberculosis infection in the United States - National trends over three decades
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DOI：
10.1164/rccm.200706-950oc
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发表时间：
2008-02-15
影响因子：
24.7
通讯作者：
Gardam, Michael
中科院分区：
文献类型：
--
作者：
Khan, Kamran;Wang, Jun;Gardam, Michael
理由：1989年，美国走上了在全国范围内消灭结核病的宏伟道路。尽管美国的结核病发病率正在下降，但这些病例仅占所有结核病感染的一小部分。了解结核病感染的国家趋势对预测结核病的未来趋势可能很重要。目的：描述1971-1972年和1999- 2000年美国结核分枝杆菌感染的流行病学。我们研究了1971年、1972年和1999年参与美国非制度化平民人口的全国代表性队列，2000年全国健康和营养检查调查。参与者进行结核菌素皮肤测试，并在调查中比较结核感染的流行病学。Logistic回归用于确定参与者和家庭特征与TB infection. Measures和主要结果之间的关联：在1999- 2000年，4.2%（95%置信区间[CI]，3.3-5.2%）的美国1岁或以上的人口显示TB感染的证据。在25-74岁人群中，感染率从1971-1972年的14.4%（95%置信区间，11.6-17.7%）下降到1999-2000年的5.6%（95%置信区间，4.4-7.1%）。25-74岁的人之间的相对感染负担下降是更大的美国出生的人口（12.6至2.5%）相比，全国的外国出生的人口（35.9至21.3%）。结论：美国经历了结核病感染的负担大幅下降，自20世纪70年代初。尽管如此，美国外国出生人口的感染率是美国出生人口的八倍多。
Rationale: In 1989, the United States embarked upon an ambitious path to eliminate tuberculosis (TB) nationwide. Although incidence rates of TB disease in the United States are declining, these cases represent only a tiny fraction of all TB infections. Understanding national trends in TB infection may be important in anticipating future trends in TB disease.Objectives: Describe the epidemiology of Mycobacterium tuberculosis infection in the United States in 1971-1972 and 1999-2000.Methods: We studied nationally representative cohorts of the U.S. non institutionalized civilian population participating in the 19711972 and 1999-2000 National Health and Nutrition Examination Surveys. Participants were tuberculin skin tested and the epidemiology of TB infection was compared across surveys. Logistic regression was used to identify associations between participant and household characteristics and TB infection.Measurements and Main Results: In 1999-2000,4.2% (95% confidence interval [CI], 3.3-5.2%) of the U.S. population aged I year or older displayed evidence of TB infection. Among persons aged 25-74, the prevalence of infection decreased from 14.4% in 1971-1972 (95% Cl, 11.6-17.7%) to 5.6% in 1999-2000 (95% Cl, 4.4-7.1%). Declines in the relative burden of infection among persons aged 25-74 were greater in the United States-born population (12.6 to 2.5%) compared with the nation's foreign-born population (35.9 to 21.3%).Conclusions: The United States has experienced a substantial decline in the burden of TB infection since the early 1970s. Despite this, the prevalence of infection among the nation's foreign-born population is over eight times greater than that observed in the United States-born population.