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Volume 19, Number 3—March 2013

CME ACTIVITY

Tuberculosis and HIV Co-infection, California, USA, 1993–2008

John Z. MetcalfeComments to Author , Travis C. Porco, Janice Westenhouse, Mark Damesyn, Matt Facer, Julia Hill, Qiang Xia, James P. Watt, Philip C. Hopewell, and Jennifer Flood
Author affiliations: Author affiliations: University of California, San Francisco, California, USA (J.Z. Metcalfe, T.C. Porco, P.C. Hopewell); California Department of Public Health, Richmond, California, USA (J. Westenhouse, J. Hill, J.P. Watt, J. Flood); California Department of Public Health, Sacramento, California, USA (M. Damesyn, M. Facer); RTI International, Research Triangle Park, North Carolina, USA (Q. Xia)

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Table 1

Demographic characteristics of TB patients with and without known HIV co-infection, California, 1993–2008*

Characteristic TB without known HIV
TB with HIV
1993–1995, n = 13,297 1996–2000, n = 17,768 2001–2008, n = 22,558 1993–1995, n = 1,343 1996–2000, n = 1,307 2001–2008, n = 1,254 p value†
Median age, y (IQR)
42 (27–62)
45 (29–64)‡
47 (30–64)‡
37 (31–44)
38 (33–45)‡
40 (34–48)‡
0.8
Female sex 5,343 (40) 7,249 (41) 9,294 (41) 147 (11) 177 (14) 217 (17) <0.001

Referent
1.0 (0.99–1.04)
1.03 (1.00–1.05)
Referent
1.2 (1.0–1.5)
1.6 (1.3–1.9)

Race/Ethnicity
Asian/Pacific Islander 4,972 (37) 7,429 (42) 10,091 (45) 52 (4) 59 (5) 105 (8) 0.002
Referent 1.12 (1.09–1.15) 1.19 (1.16–1.22) Referent 1.2 (0.8–1.7) 2.2 (1.6–3.0)
Hispanic 4,955 (38) 6,306 (35) 8,519 (38) 512 (38) 619 (47) 714 (57) <0.001
Referent 1.0 (0.9–1.0) 1.01 (0.98–1.04) Referent 1.2 (1.1–1.4) 1.5 (1.4–1.6)
Black, non-Hispanic 1,483 (11) 1,674 (10) 1,628 (7) 440 (33) 369 (28) 265 (21) 0.18
Referent 0.9 (0.8–0.9) 0.7 (0.6–0.7) Referent 0.9 (0.8–1.0) 0.6 (0.6–0.7)
White, non-Hispanic 1,776 (13) 2,197 (12) 2,174 (10) 327 (24) 252 (19) 161 (13) <0.001

Referent
0.9 (0.9–1.0)
0.7 (0.7–0.8)
Referent
0.8 (0.7–0.9)
0.5 (0.4–0.6)

Foreign born 8,951 (67) 12,635 (71) 17,296 (77) 488 (36) 597 (46) 784 (63) <0.001

Referent
1.1 (1.0–1.1)
1.1 (1.1–1.2)
Referent
1.3 (1.2–1.4)
1.7 (1.6–1.9)

Country/region of origin
Mexico 2,909 (32) 3,826 (30) 5,274 (30) 295 (60) 385 (64) 502 (64) 0.07
Referent 0.9 (0.9–1.0) 0.9 (0.9–1.0) Referent 1.1 (1.0–1.2) 1.1 (1.0–1.2)
Central America 521 (6) 611 (5) 937 (5) 77 (16) 84 (14) 93 (12) 0.05
Referent 0.8 (0.7–0.9) 0.9 (0.8–1.0) Referent 0.9 (0.7–1.2) 0.8 (0.6–1.0)
Philippines 1,745 (19) 2,669 (21) 3,580 (21) 27 (6) 28 (5) 43 (5) 0.44
Referent 1.1 (1.0–1.1) 1.1 (1.0–1.1) Referent 0.8 (0.5–1.4) 1.0 (0.6–1.6)
People’s Republic of China 504 (6) 774 (6) 1,108 (6) 3 (0.6) 2 (0.3) 2 (0.3) 0.26
Referent 1.1 (1.0–1.2) 1.1 (1.0–1.3) Referent 0.5 (0.1–3.3) 0.4 (0.1–2.5)
Mainland Southeast Asia 1,770 (20) 2,391 (19) 2,910 (17) 10 (2) 21 (4) 39 (5) <0.001
Referent 1.0 (0.9–1.0) 0.9 (0.8–0.9) Referent 1.7 (0.8–3.6) 2.4 (1.2–4.8)
Sub-Saharan Africa 92 (1) 181 (1) 331 (2) 7 (1) 25 (4) 52 (7) 0.06

Referent
1.4 (1.1–1.8)
1.9 (1.5–2.3)
Referent
2.9 (1.3–6.7)
4.6 (2.1–10.1)

Median time from US entry to TB diagnosis, y (IQR)
5.3 (1–13.6)
8.2 (2.2–17.1)‡
10 (2.2–20.8)‡
9.8 (5–15.4)
10.5 (4.5–18.5)
10.9 (3–20.7)
0.001
HIV risk group§
MSM NA NA NA 634 (47) 578 (44) 518 (41) NA
NA NA NA Referent 0.9 (0.9–1.0) 0.9 (0.8–1.0)
IDU NA NA NA 289 (22) 276 (21) 186 (15) NA
NA NA NA Referent 1.0 (0.8–1.1) 0.7 (0.6–0.8)
MSM and IDU NA NA NA 218 (16) 137 (10) 105 (8) NA
NA NA NA Referent 0.7 (0.5–0.8) 0.5 (0.4–0.6)
Heterosexual contact NA NA NA 84 (6) 112 (9) 206 (16) NA
NA NA NA Referent 1.4 (1.0–1.8) 2.6 (2.1–3.3)
Unknown NA NA NA 92 (7) 188 (14) 223 (18) NA
NA NA NA Referent 2.1 (1.7–2.7) 2.6 (2.1–3.3)
Homeless 930 (7) 1,059 (6) 1,270 (6) 244 (18) 233 (18) 239 (19) 0.01
Referent 0.9 (0.8–0.9) 0.8 (0.7–0.9) Referent 1.0 (0.8–1.2) 1.1 (0.9–1.2)
Excess alcohol use 1,270 (10) 1,897 (11) 2,071 (9) 255 (19) 298 (23) 255 (20) 0.8
Referent 1.1 (1.0–1.2) 1.0 (0.9–1.0) Referent 1.2 (1.0–1.4) 1.1 (0.9–1.3)

*TB diagnoses were grouped into 3 periods: pre-HAART (1993–1995), early HAART (1996–2000), and late HAART (2001–2008). All values are no. (%)/prevalence ratio (95% CI) unless otherwise indicated. The denominator for each characteristic excludes missing or unknown values. TB, tuberculosis; IQR, interquartile range; MSM, men who have sex with men; NA, not applicable; IDU, injection drug use.
†Rates of change in prevalence of binary covariates among patients with TB vs. patients with TB–HIV were compared by using logistic regression with robust SEs; similarly, rates of change in continuous covariates among patients with TB vs. patients with TB–HIV were compared by using linear regression. For difference in annual percentage change (TB vs. TB–HIV)
‡p<0.001 difference in medians relative to early time period.
§Other exposure categories are hemophilia/coagulation disorder; receipt of blood, components, or tissue; and perinatal transmission. These accounted for <2% of suspected risk factors for HIV acquisition during each time period and are not included in the table.

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