A cross-sectional study of latent tuberculosis infection, insurance coverage, and usual sources of health care among non-US-born persons in the United States

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dc.creatorAnnan, Esther
dc.creatorStockbridge, Erica L.
dc.creatorKatz, Dolly
dc.creatorMun, Eun-Young
dc.creatorMiller, Thaddeus L.
dc.creator.orcid0000-0002-1820-615X (Mun, Eun-Young)
dc.creator.orcid0000-0001-9816-0958 (Annan, Esther)
dc.creator.orcid0000-0001-7897-6722 (Stockbridge, Erica L.)
dc.date.accessioned2022-10-14T14:32:31Z
dc.date.available2022-10-14T14:32:31Z
dc.date.issued2021-02-19
dc.description.abstractABSTRACT: More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons' access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011-2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries' high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.
dc.identifier.citationAnnan, E., Stockbridge, E. L., Katz, D., Mun, E. Y., & Miller, T. L. (2021). A cross-sectional study of latent tuberculosis infection, insurance coverage, and usual sources of health care among non-US-born persons in the United States. Medicine, 100(7), e24838. https://doi.org/10.1097/MD.0000000000024838
dc.identifier.issn1536-5964
dc.identifier.issue7
dc.identifier.urihttps://hdl.handle.net/20.500.12503/31855
dc.identifier.volume100
dc.publisherWolters Kluwer Health, Inc.
dc.relation.urihttps://doi.org/10.1097/MD.0000000000024838
dc.rights.holderCopyright © 2021 the Author(s).
dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceMedicine
dc.subject.meshAdolescent
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshChild
dc.subject.meshCross-Sectional Studies
dc.subject.meshDelivery of Health Care / economics
dc.subject.meshDelivery of Health Care / statistics & numerical data
dc.subject.meshEmigrants and Immigrants / statistics & numerical data
dc.subject.meshFemale
dc.subject.meshHealth Services Accessibility
dc.subject.meshHumans
dc.subject.meshIncidence
dc.subject.meshInsurance Coverage / statistics & numerical data
dc.subject.meshInsurance Coverage / trends
dc.subject.meshInterferon-gamma Release Tests / methods
dc.subject.meshLatent Tuberculosis / diagnosis
dc.subject.meshLatent Tuberculosis / epidemiology
dc.subject.meshLatent Tuberculosis / prevention & control
dc.subject.meshMale
dc.subject.meshMedicare / statistics & numerical data
dc.subject.meshMiddle Aged
dc.subject.meshMycobacterium tuberculosis / immunology
dc.subject.meshNutrition Surveys / methods
dc.subject.meshPrevalence
dc.subject.meshUnited States / epidemiology
dc.subject.meshYoung Adult
dc.titleA cross-sectional study of latent tuberculosis infection, insurance coverage, and usual sources of health care among non-US-born persons in the United States
dc.typeArticle
dc.type.materialtext

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