Attribution 4.0 International (CC BY 4.0)2022-10-142022-10-142021-02-19Annan, 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.00000000000248381536-5964https://hdl.handle.net/20.500.12503/31855ABSTRACT: 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.http://creativecommons.org/licenses/by/4.0/AdolescentAdultAgedChildCross-Sectional StudiesDelivery of Health Care / economicsDelivery of Health Care / statistics & numerical dataEmigrants and Immigrants / statistics & numerical dataFemaleHealth Services AccessibilityHumansIncidenceInsurance Coverage / statistics & numerical dataInsurance Coverage / trendsInterferon-gamma Release Tests / methodsLatent Tuberculosis / diagnosisLatent Tuberculosis / epidemiologyLatent Tuberculosis / prevention & controlMaleMedicare / statistics & numerical dataMiddle AgedMycobacterium tuberculosis / immunologyNutrition Surveys / methodsPrevalenceUnited States / epidemiologyYoung AdultArticleCopyright © 2021 the Author(s).1007