Wilberschied L A, Kaye K, Fujiwara P I, Frieden T R
Bureau of Tuberculosis Control, New York City Department of Health, New York, New York 10013, USA.
J Immigr Health. 1999 Apr;1(2):65-75. doi: 10.1023/A:1021828321167.
In New York City both the proportion of total tuberculosis cases that are extrapulmonary and the proportion of total tuberculosis cases that are foreign-born have increased since 1992. We examined the association of region of birth and site of extrapulmonary tuberculosis among 3982 persons confirmed to have tuberculosis in 1995 or 1996, while controlling for age, gender, culture result, reporting facility, and HIV status. Patients born in the Middle East (odds ratio; 3.9, p = .0001), India (odds ratio = 2.5, p = .0007), other Asian countries (excluding China, Japan and countries of the former Soviet Union) (odds ratio = 2.7, p = .0001), sub-Saharan Africa (odds ratio = 2.6, p = .0001), and the Caribbean (odds ratio = 2.0, p = .0001) were more likely to have extrapulmonary disease than patients born in the United States. The proportion of total cases with extrapulmonary involvement is likely to increase in areas where the foreign-born comprise a growing proportion of all cases of tuberculosis. Although reasons for regional differences in tuberculosis disease site are not known, these findings should alert health care providers to maintain a high index of suspicion for extrapulmonary tuberculosis among some foreign-born groups.
自1992年以来，在纽约市，肺外结核病例占结核病总病例的比例以及出生于国外的结核病病例占总病例的比例均有所上升。我们在1995年或1996年确诊患有结核病的3982人中，研究了出生地区与肺外结核发病部位之间的关联，同时对年龄、性别、培养结果、报告机构和艾滋病毒感染状况进行了控制。出生于中东地区的患者（比值比；3.9，p = 0.0001）、印度（比值比 = 2.5，p = 0.0007）、其他亚洲国家（不包括中国、日本和前苏联国家）（比值比 = 2.7，p = 0.0001）、撒哈拉以南非洲（比值比 = 2.6，p = 0.0001）以及加勒比地区（比值比 = 2.0，p = 0.0001）的患者比出生在美国的患者更易患肺外疾病。在出生于国外的人口占结核病所有病例的比例不断增加的地区，肺外受累总病例的比例可能会上升。尽管结核病发病部位存在地区差异的原因尚不清楚，但这些发现应提醒医疗保健人员，对一些出生于国外的人群中的肺外结核保持高度怀疑。
