Abstract
BackgroundNovel approaches are required to better focus latent tuberculosis infection (LTBI) efforts in low-prevalence regions. Geographic information systems, used within large health systems, may provide one such approach.MethodsA retrospective, cross-sectional design was used to integrate US Census and Duke Health System data between January 1, 2010 and October 31, 2017 and examine the relationships between LTBI screening and population tuberculosis risk (assessed using the surrogate measure of proportion of persons born in tuberculosis-endemic regions) by census tract.ResultsThe median proportion of Duke patients screened per census tract was 0.01 (range 0–0.1, interquartile range 0.01–0.03). The proportion of Duke patients screened within a census tract significantly but weakly correlated with the population risk. Furthermore, patients residing in census tracts with higher population tuberculosis risk were more likely to be screened with TST than with an IGRA (p<0.001).ConclusionThe weak correlation between patient proportion screened for LTBI and our surrogate marker of population tuberculosis risk suggests that LTBI screening efforts should be better targeted. This type of geography-based analysis may serve as an easily obtainable benchmark for LTBI screening in health systems with low tuberculosis prevalence.
Highlights
Tuberculosis (TB) elimination in low-prevalence areas increasingly relies on targeted testing and treatment of latent tuberculosis infection (LTBI) [1]
Patients residing in census tracts with higher population tuberculosis risk were more likely to be screened with TST than with an interferon-gamma release assay (IGRA) (p
Census tracts with a greater proportion of higher-risk foreign-born were found to be more likely to contain a higher proportion of Duke University Health System (DUHS) patients screened for LTBI with TST or IGRA; the positive correlation was weak (Fig 3, slope = 0.068, r2 = 0.105, p
Summary
A retrospective, cross-sectional design was used to integrate US Census and Duke Health System data between January 1, 2010 and October 31, 2017 and examine the relationships between LTBI screening and population tuberculosis risk (assessed using the surrogate measure of proportion of persons born in tuberculosis-endemic regions) by census tract
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