在加利福尼亚州，入境时国内胸部 X 光片异常的移民中结核病风险增加。

Increased tuberculosis risk among immigrants arriving in California with abnormal domestic chest radiographs.

机构信息

Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.

出版信息

Int J Tuberc Lung Dis. 2018 Jan 1;22(1):73-79. doi: 10.5588/ijtld.17.0340.

DOI:10.5588/ijtld.17.0340

PMID:29297429

Abstract

SETTING

Tuberculosis (TB) cases in California, USA, occur predominantly among foreign-born persons, many of whom have abnormal chest radiographs (CXRs) on overseas medical examination. These persons are recommended for follow-up TB evaluation upon arrival in the United States.

OBJECTIVE

To estimate the increased TB risk associated with abnormal vs. normal domestic CXRs among individuals arriving with abnormal overseas CXRs.

DESIGN

Cox regression analyses of 35 633 foreign-born persons aged 15 years who arrived in California during 1999-2012 with abnormal overseas CXRs and were free of imported active TB. Domestic CXRs were conducted during post-arrival evaluation. Subsequent cases through 2014 were identified from California's TB registry.

RESULTS

A total of 121 (0.3%) arrivers developed TB disease. Progression rates were respectively 63.6 (95%CI 50.8-76.4) and 25.4 (95% CI 15.7-35.2) cases/100 000 person-years among persons with abnormal and normal domestic CXRs. Relative to arrivers with normal domestic CXRs, those with abnormal domestic CXRs had an elevated disease risk during the first 4 years after immigration; this increased risk was greatest during the first year (hazard ratio 2.9, 95%CI 1.8-4.8).

CONCLUSION

Among arrivers with abnormal overseas CXRs, those with abnormal CXRs upon domestic evaluation have an elevated disease risk and represent an important target group for preventive treatment.

摘要

背景

美国加利福尼亚州的结核病（TB）病例主要发生在外国出生的人群中，其中许多人在海外体检时胸部 X 光片（CXR）异常。这些人抵达美国后建议进行后续的 TB 评估。

目的

估计在海外 CXR 异常的个体中，与国内 CXR 正常相比，异常 CXR 与 TB 风险增加之间的关联。

设计

对 1999 年至 2012 年期间抵达加利福尼亚州的 35633 名年龄≥15 岁、海外 CXR 异常且无输入性活动性 TB 的外国出生者进行 Cox 回归分析。入境后评估时进行国内 CXR。通过加利福尼亚州的 TB 登记处，确定后续病例直至 2014 年。

结果

共有 121 例（0.3%）到达者发生 TB 病。在国内 CXR 异常和正常的到达者中，进展率分别为 63.6（95%CI 50.8-76.4）和 25.4（95%CI 15.7-35.2）例/100000 人年。与国内 CXR 正常的到达者相比，国内 CXR 异常的到达者在移民后的前 4 年中有更高的发病风险；这种风险增加在第一年最大（危险比 2.9，95%CI 1.8-4.8）。