Division of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, New York, USA.
Int J Tuberc Lung Dis. 2011 Nov;15(11):1455-60, i. doi: 10.5588/ijtld.11.0103.
Pulmonary tuberculosis (TB) patients reported in North Carolina (NC), USA, from 1996 to 2008 (inclusive).
To compare prevalence of cavitary TB as a surrogate marker for advanced disease in low-caseload counties with high-caseload counties.
A multivariate log binomial regression model was used to estimate prevalence ratios (PRs) for cavitary TB.
The proportion of TB cases in low-caseload counties vs. the total number of TB cases in NC over the study period increased from 10% in 1996 to 20% in 2008. After adjusting for human immunodeficiency virus (HIV) status, excess alcohol use and report year, patients in rural areas of low-caseload counties had greater prevalence (PR 1.40, 95%CI 1.19-1.64) of cavitary disease compared with patients from rural areas of high-caseload counties. The prevalence of cavitary TB did not differ between urban residents of high- or low-caseload counties (PR 1.00, 95%CI 0.86-1.16) after adjusting for HIV status, excess alcohol use and report year.
TB patients in rural areas of low-caseload counties presented with more advanced TB disease compared with patients from urban and/or high-caseload counties. Barriers to timely recognition of TB in rural low-caseload settings must be considered in TB control programs.
美国北卡罗来纳州（NC）1996 年至 2008 年（含）期间报告的肺结核（TB）患者。
比较低病例县和高病例县作为晚期疾病替代指标的空洞性 TB 患病率。
采用多变量对数二项式回归模型来估计空洞性 TB 的患病率比（PR）。
在研究期间，低病例县的 TB 病例比例与 NC 中的总 TB 病例数之比从 1996 年的 10%增加到 2008 年的 20%。在调整了人类免疫缺陷病毒（HIV）状态、过量饮酒和报告年份后，低病例县农村地区的患者发生空洞性疾病的流行率更高（PR1.40，95%CI1.19-1.64），而高病例县农村地区的患者则没有（PR1.00，95%CI0.86-1.16）。
与来自城市和/或高病例县的患者相比，低病例县农村地区的 TB 患者呈现出更晚期的 TB 疾病。必须考虑在结核病控制规划中，在农村低病例环境中及时识别结核病的障碍。
