Volume 8, Number 11—November 2002
THEME ISSUE
Tuberculosis Genotyping
Tuberculosis Genotyping Network, United States
Molecular Epidemiology of Tuberculosis in a Sentinel Surveillance Population
, Jack T. Crawford*, Christopher R. Braden*, Scott J. N. McNabb*, Marisa Moore*, Steve Kammerer*, and the National Tuberculosis Genotyping and Surveillance Network Work Group
Table 2
Demographic and risk behavior factors and clinical, laboratory, and treatment outcomes for the sentinel surveillance patients (National Tuberculosis Genotyping Surveillance Network, compared with factors and outcomes of all tuberculosis patients, United States, 1996–2000a,b
| Variable | Category | All U.S. TB cases (n=3,097) (%) | All NTGSN cases (n=15,035) (%) | Probabilityc |
|---|---|---|---|---|
| Gender | Male | 58,356 (62.7) | 8,767 (58.3) | <0.001 |
| Female | 34,734 (37.3) | 6,266 (41.7) | ||
| Unknown | 7 (0.0) | 2 (0.0) | ||
| Age (yrs) | <4 | 3,289 (3.5) | 518 (3.4) | NS |
| 5–14 | 2,397 (2.6) | 393 (2.6) | NS | |
| 15–24 | 7,988 (8.6) | 1,462 (9.7) | <0.001 | |
| 25–44 | 32,433 (34.8) | 5,413 (36.0) | 0.005 | |
| 45–64 | 25,319 (27.2) | 3,850 (25.6) | <0.001 | |
| >64 | 21,662 (23.3) | 3,397 (22.6) | NS | |
| Unknown | 9 (0.0) | 2 (0.0) | ||
| Race/ethnicity | White, non-Hispanic | 22,655 (24.3) | 3,087 (20.5) | <0.001 |
| Black, non-Hispanic | 30,201 (32.4) | 4,775 (31.8) | NS | |
| Hispanic | 20,475 (22.0) | 2,923 (19.4) | <0.001 | |
| American Indian/Native | 1,280 (1.4) | 38 (0.3) | <0.001 | |
| Asian/Pacific Islander | 18,346 (19.7) | 4,195 (27.9) | <0.001 | |
| Unknown | 140 (0.2) | 17 (0.1) | ||
| Place of birth | U.S.-born | 54,341 (58.4) | 7,530 (50.1) | <0.001 |
| Foreign-born | 38,252 (41.1) | 7,468 (49.7) | ||
| Unknown | 504 (0.5) | 37 (0.2) | ||
| Years in United States (foreign-born only) | <1 | 7,425 (19.4) | 1,494 (20.0) | NS |
| 1 | 2,612 (6.8) | 567 (7.6) | NS | |
| 2 | 2,073 (5.4) | 477 (6.4) | <0.005 | |
| 3 | 1,827 (4.8) | 406 (5.4) | <0.05 | |
| 4 | 1,676 (4.4) | 361 (4.8) | NS | |
| >5 | 19,396 (50.7) | 3,688 (49.4) | <0.001 | |
| Unknown | 3,243 (8.5) | 475 (6.4) | ||
| Country of origind | Philippines | 4,862 (12.7) | 1,113 (14.9) | <0.0001 |
| Mexico | 8,795 (23.0) | 1,100 (14.7) | <0.0001 | |
| Vietnam | 3,824 (10.0) | 968 (13.0) | <0.0001 | |
| India | 2,527 (6.6) | 883 (11.8) | <0.0001 | |
| China | 1,930 (5.0) | 370 (5.0) | NS | |
| Haiti | 1,470 (3.8) | 225 (3.0) | <0.0005 | |
| Peru | 636 (1.7) | 207 (2.8) | <0.0001 | |
| Republic of Korea | 1,176 (3.1) | 202 (2.7) | NS | |
| Ethiopia | 578 (1.5) | 153 (2.0) | <0.001 | |
| Ecuador | 627 (1.6) | 115 (1.5) | NS | |
| Other | 11,827 (30.9) | 2,132 (28.5) | <0.0001 | |
| Status at diagnosis | Alive | 90,141 (96.8) | 14,611 (97.2) | 0.02 |
| Dead | 2,925 (3.1)( | 422 (2.8) | ||
| Unknown | 31 (0.0) | 2 (0.0) | ||
| Site of disease | Pulmonary | 68,611 (73.7) | 10,576 (70.3) | <0.001 |
| Extrapulmonary | 17,406 (18.7) | 3,210 (21.4) | <0.001 | |
| Pulmonary and Extrapulmonary | 7,046 (7.6) | 1,241 (8.3) | 0.003 | |
| Unknown | 34 (0.0) | 8 (0.1) | ||
| Primary disease site | Pulmonary | 73,157 (78.6) | 11,365 (75.6) | <0.0001 |
| Lymph: cervical | 4,312 (4.6) | 1,020 (6.8) | <0.0001 | |
| Pleural | 3,842 (4.1) | 674 (4.5) | <0.05 | |
| Miliary | 1,407 (1.5) | 241 (1.6) | NS | |
| All other | 10,345 (11.1) | 1,727 (11.5) | NS | |
| Unknown | 34 (0.0) | 8 (0.0) | ||
| Sputum smear for acid-fast organisms | Negative | 36,912 (39.6) | 5,995 (39.9) | <0.0001 |
| Positive | 33,235 (35.7) | 4,735 (31.5) | ||
| Not done/unknown | 22,950 (24.6) | 4,305 (28.7) | ||
| TST at diagnosis | Negative | 13,215 (14.2) | 1,947 (12.9) | <0.001 |
| Positive | 54,113 (58.1) | 8,799 (58.5) | ||
| Not done/unknown | 25,769 (27.6) | 4,289 (28.6) | ||
| Case verification criteria | Positive culture | 74,940 (80.5) | 11,967 (79.6) | <0.01 |
| Positive smear | 765 (0.8) | 136 (0.9) | NS | |
| Clinical case | 11,286 (12.1) | 1,858 (12.4) | NS | |
| Provider diagnosis | 6,106 (6.6) | 1,074 (7.1) | <0.01 | |
| Chest radiographd | Cavitary | 18,742 (24.8) | 2,990 (25.3) | NS |
| Noncavitary | 50,652 (66.9) | 7,897 (66.8) | NS | |
| Normal | 2,495 (3.3) | 360 (3.0) | NS | |
| Not done/unknown | 3,802 (5.0) | 578 (4.9) | ||
| Total | 75,691 | 11,825 | ||
| HIV statuse | Positive | 6,062 (18.8) | 884 (16.7) | NS |
| Negative | 16,525 (51.2) | 2,406 (45.5) | ||
| Indeterminate | 47 (0.1) | 6 (0.1) | ||
| Refused | 1,959 (6.1) | 325 (6.1) | ||
| Not offered | 4,130 (12.8) | 899 (17.0) | ||
| Test done, unknown | 714 (2.2) | 115 (2.2) | ||
| Unknown | 2,812 (8.7) | 658 (12.4) | ||
| Total | 32,249 | 5,293 | ||
| Homeless within past year | Yes | 5,789 (6.2) | 646 (4.3) | <0.001 |
| No | 84,873 (91.2) | 14,185 (94.3) | ||
| Unknown | 2,435 (2.6) | 204 (1.4) | ||
| Resident of correctional facility at diagnosis | Yes | 3,352 (3.6) | 377 (2.5) | <0.001 |
| No | 89,479 (96.1) | 14,617 (97.2) | ||
| Unknown | 266 (0.3) | 41 (0.3) | ||
| Correctional facility type | Federal prison | 164 (4.9) | 6 (1.6) | <0.005 |
| State prison | 1,036 (30.9) | 97 (25.7) | <0.05 | |
| Local jail | 1,905 (56.8) | 231 (61.3) | NS | |
| Juvenile facility | 33 (1.0) | 8 (2.1) | NS | |
| Other | 161 (4.8) | 34 (9.0) | <0.001 | |
| Unknown | 53 (1.6) | 1 (0.3) | ||
| Total | 3,352 | 377 | ||
| Resident, long-term care facility at diagnosis | Yes | 3,157 (3.4) | 441 (2.9) | 0.004 |
| No | 89,656 (96.3) | 14,552 (96.8) | ||
| Unknown | 284 (0.3) | 42 (0.3) | ||
| Long-term care facility type | Nursing home | 1,794 (56.8) | 279 (63.3) | <0.01 |
| Hospital-based | 441 (14.0) | 66 (15.0) | NS | |
| Residential | 356 (11.3) | 34 (7.7) | <0.05 | |
| All other | 504 (16.0) | 55 (12.5) | NS | |
| Unknown | 62 (2.0) | 7 (1.6) | ||
| Total | 3,157 | 441 | ||
| Injecting drug usef | Yes | 2,569 (2.8) | 515 (3.4) | <0.001 |
| No | 83,141 (89.3) | 13,771 (91.6) | ||
| Unknown | 7,387 (7.9) | 749 (5.0) | ||
| Noninjecting drug usef | Yes | 6,557 (7.0) | 811 (5.4) | <0.001 |
| No | 78,622 (84.5) | 13,367 (88.9) | ||
| Unknown | 7,918 (8.5) | 857 (5.7) | ||
| Excessive alcohol useg | Yes | 13,646 (14.7) | 1,661 (11.0) | <0.001 |
| No | 71,924 (77.3) | 12,552 (83.5) | ||
| Unknown | 7,527 (8.1) | 822 (5.5) | ||
| Drug resistanceh | ||||
| First-line drugs | Yes | 8,456 (11.7) | 1,482 (12.6) | <0.001 |
| No | 57,029 (79.0) | 8,886 (75.5) | ||
| Not tested/unknown | 6,703 (9.3) | 1,399 (11.9) | ||
| Total | 72,188 | 11,767 | ||
| Second-line drugs | Yes | 1,341 (1.9) | 208 (1.8) | <0.001 |
| No | 175 (0.2) | 78 (0.7) | ||
| Not tested/unknown | 70,672 (97.9) | 11,481 (97.6) | ||
| Total | 72,188 | 11,767 | ||
| DOT | Yes—total DOT | 40,511 (43.5) | 4,936 (32.8) | <0.001 |
| Yes—both DOT and self-administered | 20,555 (22.1) | 3,648 (24.3) | <0.001 | |
| No | 23,337 (25.1) | 5,326 (35.4) | <0.001 | |
| Unknown | 8,694 (9.3) | 1,125 (7.5) | ||
| Within city limits | Yes | 80,775 (86.8) | 14,603 (97.1) | <0.001 |
| No | 10,916 (11.7) | 374 (2.5) | ||
| Unknown | 1,406 (1.5) | 58 (0.4) | ||
| Previous diagnosis of TB | Yes | 4,794 (5.1) | 652 (4.3) | <0.001 |
| No | 87,567 (94.1) | 14,336 (95.4) | ||
| Unknown | 736 (0.8) | 47 (0.3 | ||
| Duration of therapy (days) | Mean | 246 | 245 | NS |
| Median | 217 | 214 | ||
| Std. dev. | 135 | 130 | ||
| No. | 65,344 | 10,822 | ||
aNTGSN, National Tuberculosis Genotyping Surveillance Network;TB, tuberculosis; DOT, directly observed therapy; TST, tuberculin skin test; Std. dev., standard deviation; NS, not significant (p>0.05).
.bSubtotals for each category are listed if different from the total case numbers.
cProbability of significant differences between U.S. TB patients and all NTGSN surveillance patients (chi-square test; t-test for duration of therapy); referent group is all other groups combined, excluding not done or unknown categories, unless otherwise noted.
dTop 10 countries for foreign-born patients only.
eExcludes cases with extrapulmonary TB only.
fHIV cases from California are excluded because this site does not report HIV results on Report of a Verified Case of Tuberculosis forms; ages 15–44 years only.
gInjecting or noninjecting drug use within last year; includes use of licensed, prescription, or illegal drugs (not prescribed by a physician).
hExcessive use of alcohol within the past year as indicated by participation in alcohol treatment programs, diagnosis of alcoholism, or observation of intoxication during visits to health-care facilities.
iDrug resistance on initial testing of isolate. First-line drug resistance is resistance to at least one of the following: isoniazid, rifampin, ethambutol, or streptomycin. Second-line drug resistance is resistance to one or more of the following: ethionamide, kanamycin, cycloserine, capreomycin, para-amino salicylic acid, amikacin, rifabutin, ciprofloxacin, ofloxacin, or other drugs. Testing results for one or more of the drugs could have been missing.
1 Members of the National Tuberculosis Genotyping and surveillance Network Work Group, in addition to the listed authors, included Joseph Bates, William Benjamin, Pablo Bifani, M. Donald Cave, Rebecca Cox, Wendy Cronin, Ed Desmond, Jeffrey Driscoll, Nancy Dunlap, Jennifer Flood, Kashef Ijaz,, Michael Kucab, Barry Kreiswirth, Zary Liu, D. Mitchell Magee, Jeffrey Massey, Ann Miller, Donna Mulcahy, Robert Pratt, Teresa Quitugua, Barbara Schable, Kenneth Shilkret, Harry Taber, Jeffrey Taylor, Sharon Sharnprapai, Sumi Sun, Zhenhua Yang