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Free Content Increased prevalence of advanced tuberculosis in rural low tuberculosis caseload counties in North Carolina

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SETTING: Pulmonary tuberculosis (TB) patients reported in North Carolina (NC), USA, from 1996 to 2008 (inclusive). OBJECTIVE: To compare prevalence of cavitary TB as a surrogate marker for advanced disease in low-caseload counties with high-caseload counties. DESIGN: A multivariate log binomial regression model was used to estimate prevalence ratios (PRs) for cavitary TB. RESULTS: The proportion of TB cases in low-caseload counties vs. the total number of TB cases in NC over the study period increased from 10% in 1996 to 20% in 2008. After adjusting for human immunodeficiency virus (HIV) status, excess alcohol use and report year, patients in rural areas of low-caseload counties had greater prev- alence (PR 1.40, 95%CI 1.19–1.64) of cavitary disease compared with patients from rural areas of high-caseload counties. The prevalence of cavitary TB did not differ between urban residents of high- or low-caseload counties (PR 1.00, 95%CI 0.86–1.16) after adjusting for HIV status, excess alcohol use and report year. DISCUSSION: TB patients in rural areas of low-caseload counties presented with more advanced TB disease compared with patients from urban and/or high-caseload counties. Barriers to timely recognition of TB in rural low-caseload settings must be considered in TB control programs.
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Keywords: ADVANCED TUBERCULOSIS; EPIDEMIOLOGY; RURAL

Document Type: Research Article

Affiliations: 1: Division of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, New York, USA; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 2: Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 3: Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 4: Division of Infectious Diseases, Duke University, Durham, North Carolina, USA

Publication date: November 1, 2011

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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