New York City Department of Health and Mental Hygiene, Bureau of TB Control, Long Island City, NY 11101, USA.
J Public Health Manag Pract. 2011 Sep-Oct;17(5):421-6. doi: 10.1097/PHH.0b013e31820759b8.
Proper management and prevention can radically decrease the incidence of tuberculosis (TB). To further decrease TB cases in New York City, every opportunity for prevention must be utilized. This study sought to identify patients whose disease could have been prevented and describe missed opportunities for TB prevention.
Patients diagnosed with TB from April to July, 2003 were identified using the New York City TB registry. Surveillance data, medical records, and patient interviews were used to determine whether patients missed a prevention opportunity or potential for screening. Preventable TB was defined as inappropriate screening of contacts and immigrants, inappropriate treatment of persons with prior TB diagnoses, or those who tested positive for latent TB infection (LTBI) as contacts, immigration, or in community settings. Potentially preventable TB was defined as occurring when those eligible for LTBI screening in community settings were not screened more than 1 year before TB diagnosis. Patients classified as having preventable or potentially preventable TB were grouped as patients with missed opportunities. We calculated the odds of missing a prevention opportunity using logistic regression.
Among the 218 study patients, 22% had preventable TB and 35% had potentially preventable TB. The most common missed opportunity among patients with preventable TB was the failure to initiate LTBI treatment. Birth outside of the United States was not associated with missing a prevention opportunity (odds ratio [OR] = 1.31, confidence interval [CI] = 0.71-2.39); however, extended travel outside of the United States increased the odds (OR = 2.51, CI = 1.19-5.69), particularly among non-US-born patients (OR = 3.01, CI = 1.21-8.59). Missed screening opportunities related to pregnancy, employment, or school attendance were encountered by over half of the study patients.
The majority of New York City TB patients in our cohort experienced at least 1 missed opportunity for prevention. Further study is warranted to determine whether LTBI treatment eligibility should be extended to those who travel for extended periods, particularly among the non-US-born patients.
适当的管理和预防可以大大降低结核病（TB）的发病率。为了进一步减少纽约市的结核病病例，必须利用每一个预防机会。本研究旨在确定哪些患者的疾病可以得到预防，并描述预防结核病的机会错失情况。
使用纽约市结核病登记册，确定 2003 年 4 月至 7 月期间被诊断患有结核病的患者。使用监测数据、病历和患者访谈来确定患者是否错过了预防机会或筛查的可能性。可预防的结核病定义为接触者和移民的不适当筛查、既往结核病诊断患者的不适当治疗，或作为接触者、移民或在社区环境中检测到潜伏性结核感染（LTBI）呈阳性的人。潜在可预防的结核病定义为在社区环境中符合 LTBI 筛查条件的人在结核病诊断前 1 年以上未接受筛查时发生。将被归类为具有可预防或潜在可预防结核病的患者分为错失机会的患者。我们使用逻辑回归计算错失预防机会的可能性。
在 218 名研究患者中，22%有可预防的结核病，35%有潜在可预防的结核病。在有可预防结核病的患者中，最常见的错失机会是未能启动 LTBI 治疗。出生于美国境外与错失预防机会无关（比值比 [OR] = 1.31，置信区间 [CI] = 0.71-2.39）；然而，美国境外的长期旅行增加了这种可能性（OR = 2.51，CI = 1.19-5.69），尤其是对于非美国出生的患者（OR = 3.01，CI = 1.21-8.59）。超过一半的研究患者错过了与怀孕、就业或上学有关的筛查机会。
我们队列中的大多数纽约市结核病患者至少经历了一次预防机会的错失。需要进一步研究，以确定是否应将 LTBI 治疗资格扩大到那些长期旅行的人，尤其是非美国出生的患者。
