Achkar Jacqueline M, Sherpa Tsering, Cohen Hillel W, Holzman Robert S
Department of Medicine and Epidemiology, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
Clin Infect Dis. 2008 Nov 15;47(10):1277-83. doi: 10.1086/592572.
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.
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 >or=8 weeks before hospital admission for each group were estimated using logistic regression.
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 = .0002) 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., >or=8 weeks).
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.
美国大多数结核病（TB）病例是在出生于国外的人群中诊断出来的，而无合法身份的出生于国外的人在及时获得医疗服务方面可能面临特殊障碍。本研究调查了肺结核患者临床表现的差异是否与出生于国外或身份文件状况有关。
在这项横断面研究中，我们回顾了1999年4月至2005年3月期间在纽约市一家公立医院被诊断为微生物学确诊肺结核的患者的病历。定义并比较了三组肺结核患者（美国出生的人、有文件证明的出生于国外的人以及无合法身份的出生于国外的人）在就诊时的情况。使用逻辑回归估计每组入院前症状持续时间≥8周的比值比（OR）。
在194例新诊断为肺结核的受试者中，61例（31%）是美国出生的，62例（32%）是有文件证明的出生于国外的人，71例（37%）是无合法身份的出生于国外的人。与美国出生的人相比，无合法身份的出生于国外的人咳嗽（P = 0.020）和咯血（P = 0.012）的频率显著更高，症状的中位持续时间显著更长（8周对4周；P = 0.023）。在有文件证明的出生于国外的人和美国出生的人之间未观察到统计学上的显著差异。多变量分析显示，无合法身份状态（与美国出生相比；调整后的OR，4.1；95%置信区间，1.7 - 10.2；P = 0.0002）和失业（调整后的OR，2.2；95%CI，1.1 - 4.5；P = 0.023）与症状持续时间延长（即≥8周）独立相关。
无合法身份状态与咳嗽和咯血频率增加以及肺结核医疗评估前症状持续时间延长有关。减少无合法身份的出生于国外的人获得医疗服务的障碍是否能加强结核病控制值得进一步研究。
