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Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006.

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Date
2008-04-04
Authors
Kipp, Aaron M
Stout, Jason E
Hamilton, Carol Dukes
Van Rie, Annelies
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Abstract
BACKGROUND: The proportion of extrapulmonary tuberculosis (EPTB) reported in the United States has been gradually increasing. HIV infection and foreign birth are increasingly associated with tuberculosis and understanding their effect on the clinical presentation of tuberculosis is important. METHODS: Case-control study of 6,124 persons with tuberculosis reported to the North Carolina Division of Public health from January 1, 1993 to December 31, 2006. Multivariate logistic regression was used to obtain adjusted odds ratios measuring the associations of foreign birth region and US born race/ethnicity, by HIV status, with EPTB. RESULTS: Among all patients with tuberculosis, 1,366 (22.3%) had EPTB, 563 (9.2%) were HIV co-infected, and 1,299 (21.2%) were foreign born. Among HIV negative patients, EPTB was associated with being foreign born (adjusted ORs 1.36 to 5.09, depending on region of birth) and with being US born, Black/African American (OR 1.84; 95% CI 1.42, 2.39). Among HIV infected patients, EPTB was associated with being US born, Black/African American (OR 2.60; 95% CI 1.83, 3.71) and with foreign birth in the Americas (OR 5.12; 95% CI 2.84, 9.23). CONCLUSION: Foreign born tuberculosis cases were more likely to have EPTB than US born tuberculosis cases, even in the absence of HIV infection. Increasing proportions of foreign born and HIV-attributable tuberculosis cases in the United States will likely result in a sustained burden of EPTB. Further research is needed to explore why the occurrence and type of EPTB differs by region of birth and whether host genetic and/or bacterial variation can explain these differences in EPTB.
Type
Journal article
Subject
AIDS-Related Opportunistic Infections
Case-Control Studies
Emigration and Immigration
Female
HIV Infections
Humans
Male
Middle Aged
North Carolina
Odds Ratio
Tuberculosis
Permalink
https://hdl.handle.net/10161/11068
Published Version (Please cite this version)
10.1186/1471-2458-8-107
Publication Info
Kipp, Aaron M; Stout, Jason E; Hamilton, Carol Dukes; & Van Rie, Annelies (2008). Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006. BMC Public Health, 8. pp. 107. 10.1186/1471-2458-8-107. Retrieved from https://hdl.handle.net/10161/11068.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Hamilton

Carol Dukes Hamilton

Professor Emeritus of Medicine
Carol Dukes Hamilton, MD, MHS is a Professor of Medicine, Emeritus, in the Infectious Diseases Division, Department of Medicine, Duke University Medical Center.  She has nearly 40 years of experience spanning clinical care, research, public health, and global leadership. She served as clinician and full-time faculty at Duke University Medical Center from 1991 until 2008, concentrating on outpatient and inpatient clinical care (HIV/AIDS, tuberculosis [TB], and routine infectious disease prob
Stout

Jason Eric Stout

Professor of Medicine
My research focuses on the epidemiology, natural history, and treatment of tuberculosis and nontuberculous mycobacterial infections. I am also interested in the impact of HIV infection on mycobacterial infection and disease, and in examining health disparities as they relate to infectious diseases, particularly in immigrant populations.
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