Methodological issues in quantifying the magnitude of the tuberculosis problem in a prison population
OBJECTIVE: To critically discuss calculations for epidemiological indicators of the tuberculosis (TB) burden in prisons and to provide recommendations to improve study comparability.
METHODS: A hypothetical data set illustrates issues in determining incidence and prevalence. The appropriate calculation of the incidence rate is presented and problems arising from cross-sectional surveys are clarified.
RESULTS: Cases recognized during the first 3 months should be classified as prevalent at entry and excluded from any incidence rate calculation. The numerator for the incidence rate includes persons detected as having developed TB during a specified period of time subsequent to the initial 3 months. The denominator is person-time at risk from 3 months onward to the end point (TB or end of the observation period). Preferably, entry time, exit time and event time are known for each inmate to determine person-time at risk. Failing that, an approximation consists of the sum of monthly head counts, excluding prevalent cases and those persons no longer at risk from both the numerator and the denominator.
CONCLUSIONS: The varying durations of inmate incarceration in prisons pose challenges for quantifying the magnitude of the TB problem in the inmate population. Recommendations are made to measure incidence and prevalence.
Document Type: Regular Paper
Affiliations: 1: International Union Against Tuberculosis and Lung Disease, Paris, France; and Institute of Social and Preventive Medicine, University of Zurich, Switzerland 2: Health Protection Agency, London, UK 3: KNCV Tuberculosis Foundation, The Hague, The Netherlands 4: Robert Koch Institute, Berlin, Germany 5: Federal Office of Public Health, Berne, Switzerland 6: Centre for Health Protection, Hong Kong, China 7: Institute of Social and Preventive Medicine, University of Berne, Switzerland
Publication date: May 1, 2011
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