Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006.
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 articleSubject
AIDS-Related Opportunistic InfectionsCase-Control Studies
Emigration and Immigration
Female
HIV Infections
Humans
Male
Middle Aged
North Carolina
Odds Ratio
Tuberculosis
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https://hdl.handle.net/10161/11068Published Version (Please cite this version)
10.1186/1471-2458-8-107Publication 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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Show full item recordScholars@Duke
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
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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