Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health , New Haven, Connecticut, USA.
Clin Infect Dis. 2022 May 3;74(9):1594-1603. doi: 10.1093/cid/ciab668.
Older age is a risk factor for tuberculosis (TB) in low incidence settings. Using data from the US National TB Surveillance System and American Community Survey, we estimated trends and racial/ethnic differences in TB incidence among US-born cohorts aged ≥50 years.
In total, 42 000 TB cases among US-born persons ≥50 years were reported during 2001-2019. We used generalized additive regression models to decompose the effects of birth cohort and age on TB incidence rates, stratified by sex and race/ethnicity. Using genotype-based estimates of recent transmission (available 2011-2019), we implemented additional models to decompose incidence trends by estimated recent versus remote infection.
Estimated incidence rates declined with age, for the overall cohort and most sex and race/ethnicity strata. Average annual percentage declines flattened for older individuals, from 8.80% (95% confidence interval [CI] 8.34-9.23) in 51-year-olds to 4.51% (95% CI 3.87-5.14) in 90-year-olds. Controlling for age, incidence rates were lower for more recent birth cohorts, dropping 8.79% (95% CI 6.13-11.26) on average between successive cohort years. Incidence rates were substantially higher for racial/ethnic minorities, and these inequalities persisted across all birth cohorts. Rates from recent infection declined at approximately 10% per year as individuals aged. Rates from remote infection declined more slowly with age, and this annual percentage decline approached zero for the oldest individuals.
TB rates were highest for racial/ethnic minorities and for the earliest birth cohorts and declined with age. For the oldest individuals, annual percentage declines were low, and most cases were attributed to remote infection.
在低发病率环境中，年龄较大是结核病（TB）的一个危险因素。利用来自美国国家结核病监测系统和美国社区调查的数据，我们估计了≥50 岁的美国出生队列中结核病发病率的趋势和种族/民族差异。
在 2001-2019 年期间，共报告了 42000 例≥50 岁的美国出生者结核病病例。我们使用广义加性回归模型，根据性别和种族/民族对出生队列和年龄对结核病发病率的影响进行分解。使用基于基因型的近期传播估计值（2011-2019 年可用），我们实施了额外的模型，按估计的近期和远程感染对发病率趋势进行分解。
估计的发病率随年龄增长而下降，在整个队列和大多数性别和种族/民族群体中均如此。对于年龄较大的个体，平均每年的百分比下降趋于平稳，从 51 岁人群中的 8.80%（95%置信区间[CI]8.34-9.23）降至 90 岁人群中的 4.51%（95% CI 3.87-5.14）。在控制年龄的情况下，发病率随着出生队列的推移而降低，平均每年下降 8.79%（95% CI 6.13-11.26）。与白人相比，少数民族的发病率要高得多，而且这种不平等现象在所有出生队列中都存在。随着年龄的增长，近期感染的发病率每年下降约 10%。随着年龄的增长，来自远程感染的发病率下降速度较慢，对于最年长的个体，该年度百分比下降接近零。
结核病发病率在少数族裔和最早的出生队列中最高，且随年龄增长而下降。对于最年长的个体，每年的百分比下降幅度较低，而且大多数病例归因于远程感染。
