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Volume 14, Number 9—September 2008

Dispatch

Crack Cocaine and Infectious Tuberculosis

Alistair StoryComments to Author , Graham Bothamley, and Andrew Hayward
Author affiliations: Health Protection Agency, London, UK (A. Story); Homerton Hospitals National Health Service Foundation Trust, London (G. Bothamley); University College London Centre for Infectious Disease Epidemiology, London (A. Hayward)

Main Article

Table 1

Univariate analysis of drug-using and non–drug-using patients with pulmonary TB in London, United Kingdom, 2003–2004*


 Variable No known drug use, 
n = 833, 
no. (%) Hard-drug user (unconfirmed crack cocaine user), n = 115, no. (%) Hard-drug user (confirmed crack cocaine user), n = 22, no. (%) p value
Gender <0.0001
Male 445 (54.1) 99 (86.8) 12 (54.6)
Female
377 (45.9)
15 (13.2)
10 (45.5)

Ethnicity <0.0001
White 142 (17.1) 54 (47.0) 5 (22.7)
Black African 344 (41.5) 25 (21.7) 5 (22.7)
Black Caribbean 32 (3.9) 15 (13.0) 9 (40.9)
South Asian 244 (29.4) 17 (14.8) 0
Other
68 (8.2)
4 (3.5)
3 (13.6)

Born in the United Kingdom 162 (19.6) 62 (54.9) 14 (63.7) <0.0001
Previous TB 78 (9.4) 25 (21.7) 5 (22.7) <0.0001

Previous TB past 2 years (relapsed) 36 (4.3) 19 (16.5) 4 (18.2) <0.0001
Known HIV+ 95 (11.4) 9 (7.8) 3 (13.6) 0.478
Delay in diagnosis >3 mo 109 (13.1) 19 (16.5) 2 (9.1) 0.499
Sought treatment at ED 126 (15.1) 32 (27.8) 10 (45.6) <0.0001
Cough during initial examination 589 (70.7) 99 (86.1) 19 (86.40 0.001
Sputum smear positive at diagnosis 302 (36.3) 68 (59.1) 19 (86.4) <0.0001
MDR 32 (3.8) 7 (6.1) 0 0.333
Linked to known INH resistance outbreak 9 (1.1) 10 (8.7) 11 (50.0) <0.0001
INH resistance (not outbreak) 54 (6.5) 11 (9.6) 1 (4.5) 0.783
Treated with DOT from start 74 (9.0) 19 (16.5) 6 (27.3) 0.001
Nonadherent to treatment in first 2 mo 125 (15.0) 59 (51.3) 15 (68.2) <0.0001

Lost to follow-up 19 (2.3) 12 (10.4) 6 (27.3) <0.0001
Homeless 37 (4.4) 22 (19.1) 13 (59.1) <0.0001
Mental health problems 28 (3.4) 27 (23.5) 9 (40.9) <0.0001
Imprisoned during current episode of TB 9 (1.1) 22 (19.1) 14 (63.6) <0.0001

*TB, tuberculosis; ED, emergency department; MDR, multidrug resistant; INH, isoniazid; DOT, directly observed therapy.

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