TABLE 1—
Characteristics of Tuberculosis Patients Born in South Asia Compared With Other Asian and Other Foreign-Born Patients: New York City, 2001–2010
| Characteristic | South Asiana No. (%) or Median (Range) | Other Asianb No. (%) or Median (Range) | Unadjusted OR (95% CI)c | Other Foreign-Bornd No. (%) or Median (Range) | Unadjusted OR (95% CI)c |
| Total | 795 | 1470 | 4360 | ||
| Demographics | |||||
| Country of birth | |||||
| India | 317 (40) | ||||
| Bangladesh | 211 (27) | ||||
| Pakistan | 179 (23) | ||||
| Nepal | 65 (8) | ||||
| Sri Lanka | 11 (1) | ||||
| Afghanistan | 10 (1) | ||||
| Bhutan | 2 (0) | ||||
| Sex: female | 293 (37) | 567 (39) | 1.1 (0.9, 1.3) | 1656 (38) | 1.0 (0.9, 1.2) |
| Age group, y | |||||
| 0–5 | 5 (1) | 0 (0) | . . . | 32 (1) | 0.9 (0.3, 2.2) |
| 6–18 | 34 (4) | 26 (2) | 2.5 (1.5, 4.2) | 179 (4) | 1.0 (0.7, 1.5) |
| 19–44 | 450 (57) | 613 (42) | 1.8 (1.5, 2.2) | 2486 (57) | 1.0 (0.8, 1.1) |
| 45–64 | 206 (26) | 455 (31) | 0.8 (0.6, 0.9) | 1095 (25) | 1.0 (0.9, 1.2) |
| ≥65 | 100 (13) | 376 (26) | 0.4 (0.3, 0.5) | 568 (13) | 1.0 (0.8, 1.2) |
| Median age (interquartile range) | 38 (27 to 53) | 49 (33 to 65) | < 0.01 | 39 (28 to 53) | 0.21 |
| Years in the United States before diagnosis | |||||
| < 5 | 397 (50) | 478 (33) | 2.0 (1.8, 2.5) | 1560 (36) | 1.8 (1.5, 2.1) |
| 5 to < 10 | 136 (17) | 275 (19) | 0.9 (0.7, 1.1) | 815 (19) | 0.9 (0.7, 1.1) |
| 10 to < 15 | 97 (12) | 213 (14) | 0.8 (0.6, 1.1) | 527 (12) | 1.0 (0.8, 1.3) |
| 15 to < 20 | 64 (8) | 175 (12) | 0.6 (0.5, 0.9) | 414 (10) | 0.8 (0.6, 1.1) |
| ≥ 20 | 84 (11) | 300 (20) | 0.5 (0.4, 0.6) | 919 (21) | 0.4 (0.3, 0.6) |
| Median (range) | 4 (0 to 52) | 9 (−1 to 71) | < 0.01 | 8 (−1 to 86) | < 0.01 |
| Neighborhood povertye | |||||
| Low (< 10%) | 138 (17) | 226 (16) | 1.1 (0.9, 1.4) | 610 (14) | 1.3 (1.0, 1.6) |
| Medium (10% to < 20%) | 365 (46) | 476 (33) | 1.8 (1.5, 2.1) | 1212 (28) | 2.2 (1.9, 2.5) |
| High (20% to < 30%) | 209 (26) | 438 (30) | 0.8 (0.7, 1.0) | 1259 (30) | 0.9 (0.7, 1.0) |
| Very high (≥ 30%) | 74 (9) | 305 (21) | 0.4 (0.3, 0.5) | 1168 (27) | 0.3 (0.2, 0.4) |
| Employed in the 24 mo before diagnosisf | 384 (50) | 626 (43) | 1.3 (1.1, 1.6) | 2174 (51) | 0.9 (0.8, 1.1) |
| Ever employed as a health care workerf | 53 (7) | 87 (6) | 1.2 (0.8, 1.7) | 221 (5) | 1.4 (1.0, 1.9) |
| Ever homeless | 9 (1) | 30 (2) | 0.5 (0.3, 1.2) | 160 (4) | 0.3 (0.1, 0.6) |
| Ever incarcerated | 0 (0) | 6 (0) | . . . | 58 (1) | . . . |
| Ever used alcohol | 47 (6) | 86 (6) | 1.1 (0.7, 1.5) | 603 (14) | 0.4 (0.3, 0.5) |
| Ever used tobaccog | 113 (21) | 319 (32) | 0.6 (0.4, 0.7) | 612 (22) | 1.0 (0.8, 1.2) |
| Ever used illegal drugs | 6 (1) | 18 (1) | 0.6 (0.2, 1.6) | 179 (4) | 0.2 (0.1, 0.4) |
| Clinical characteristics | |||||
| HIV positive | 13 (2) | 20 (1) | 1.2 (0.6, 2.4) | 500 (11) | 0.1 (0.1, 0.2) |
| HIV negative | 513 (65) | 803 (55) | 1.5 (1.3, 1.8) | 2840 (65) | 1.0 (0.8, 1.1) |
| HIV not offered/unknown/missing | 56 (7) | 104 (7) | 1.0 (0.7, 1.4) | 291 (7) | 1.1 (0.8, 1.4) |
| HIV refused | 213 (27) | 543 (37) | 0.6 (0.5, 0.8) | 729 (17) | 1.8 (1.5, 2.2) |
| Female | 103 (48) | 219 (40) | 0.7 (0.5, 1.0) | 351 (48) | 1.0 (0.7, 1.3) |
| Aged 0–5 y | 1 (0) | 0 (0) | . . . | 10 (1) | 0.3 (0.0, 2.7) |
| Aged 6–18 y | 15 (7) | 8 (1) | 5.1 (2.1, 12.1) | 36 (5) | 1.5 (0.8, 2.7) |
| Aged 19–44 y | 92 (43) | 147 (27) | 2.0 (1.5, 2.9) | 255 (35) | 1.4 (1.0, 1.9) |
| Aged 45–64 y | 60 (28) | 181 (33) | 0.8 (0.6, 1.1) | 209 (29) | 1.0 (0.7, 1.4) |
| Aged ≥ 65 y | 45 (21) | 207 (38) | 0.4 (0.3, 0.6) | 219 (30) | 0.6 (0.4, 0.9) |
| Clinical characteristics | |||||
| History of TB infectionh | 64 (8) | 145 (10) | 0.8 (0.6, 1.1) | 448 (10) | 0.8 (0.6, 1.0) |
| Site of disease | |||||
| Extrapulmonary only | 285 (36) | 282 (19) | 2.4 (1.9, 2.9) | 1080 (25) | 1.7 (1.4, 2.0) |
| Pulmonary only | 435 (55) | 1063 (72) | 0.5 (0.4, 0.6) | 2830 (65) | 0.7 (0.6, 0.8) |
| Both | 75 (9) | 125 (9) | 1.1 (0.8, 1.5) | 450 (10) | 0.9 (0.7, 1.2) |
| Extrapulmonary sites of diseasei | |||||
| Lymphatic | 172 (60) | 135 (48) | 1.7 (1.2, 2.3) | 476 (44) | 1.9 (1.5, 2.5) |
| Bone/joint | 36 (13) | 43 (15) | 0.8 (0.5, 1.3) | 141 (13) | 1.0 (0.7, 1.4) |
| Pleural | 29 (10) | 58 (21) | 0.4 (0.3, 0.7) | 177 (16) | 0.6 (0.4, 0.9) |
| Peritoneal | 13 (5) | 13 (5) | 1.0 (0.5, 2.2) | 58 (5) | 0.8 (0.5, 1.6) |
| Meningeal | 7 (2) | 6 (2) | 1.2 (0.4, 3.5) | 70 (6) | 0.4 (0.2, 0.8) |
| Any pulmonary involvement | 510 (64) | 1188 (81) | 0.4 (0.3, 0.5) | 3280 (75) | 0.6 (0.5, 0.7) |
| AFB positive respiratory smear | 252 (49) | 639 (54) | 0.8 (0.7, 1.0) | 1883 (57) | 0.7 (0.6, 0.9) |
| Abnormal initial chest x-ray result | 487 (95) | 1153 (97) | 0.6 (0.3, 1.0) | 3088 (94) | 1.2 (0.7, 1.9) |
| Abnormal: cavitiesj | 116 (24) | 191 (17) | 1.5 (1.2, 2.0) | 670 (22) | 1.1 (0.9, 1.4) |
| Culture positive | 612 (77) | 1200 (82) | 0.8 (0.6, 1.0) | 3328 (76) | 1.1 (0.9, 1.3) |
| Drug susceptibility testing performed | 604 (99) | 1177 (98) | 1.2 (0.5, 2.8) | 3286 (99) | 0.8 (0.4, 1.7) |
| Susceptible | 449 (74) | 905 (77) | 0.9 (0.7, 1.1) | 2535 (77) | 0.9 (0.7, 1.0) |
| Multidrug resistance (MDR)k | 12 (2) | 18 (2) | 1.3 (0.6, 2.7) | 63 (2) | 1.0 (0.6, 1.9) |
| Extensive drug resistance (XDR)l | 1 (8) | 1 (6) | 1.5 (0.1, 27.4) | 5 (8) | 1.1 (0.1, 9.9) |
| Other resistance | 143 (24) | 254 (22) | 1.1 (0.9, 1.4) | 688 (21) | 1.2 (1.0, 1.4) |
| Genotyping | |||||
| Complete genotypem | 561 (92) | 1103 (92) | 0.7 (0.4, 1.1) | 3187 (96) | 0.5 (0.3, 0.8) |
| Total number of TB strains | 381 | ||||
| Clusteredn | 111 (20) | 243 (22) | 0.9 (0.7, 1.1) | 1310 (41) | 0.4 (0.3, 0.4) |
| No. of clusters patients fall into | 49 | ||||
| Median cluster size (range) | 3 (2 to 185) | ||||
| RFLP with < 6 bands | 70 (63) | ||||
| RFLP with 1 bando | 53 (76) | ||||
| No. of patients investigated | 105 (95) | ||||
| Epidemiological links identifiedp | 24 (23) | ||||
| Definite linksq | 15 (63) | ||||
| Nonhousehold linkq | 3 (20) | ||||
Note. AFB = acid-fast bacilli; CI = confidence interval; OR = odds ratio; RFLP = restriction fragment length polymorphism; TB = tuberculosis.
South Asia included India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, the Maldives, and Afghanistan (World Bank Definition). Patients identified as Tibetan were excluded.
Other Asian countries included Cambodia, China, East Timor, Fiji, Indonesia, Kiribati, North Korea, Laos, Malaysia, Marshall Islands, Micronesia, Mongolia, Myanmar, Palau, Papua New Guinea, Philippines, Samoa, Solomon Islands, South Korea, Thailand, Tonga, Tuvalu, Vanuatu, and Vietnam.
Unadjusted ORs and 95% CIs were calculated excluding missing values and comparing South Asians with other Asian/other foreign-born.
Other foreign-born was defined as all non–US-born individuals, excluding those classified as South Asian or other Asian.
Neighborhood poverty was measured using US Census Data on the percentage of residents in a census tract living below 100% of the federal poverty limit. For patients identified before 2005, poverty data were taken from the 2000 Decennial Census. American Community Survey 5-year sample poverty data were used for patients identified from 2005 to 2010. One hundred twenty patients who were homeless at reporting and 25 patients with addresses that could not be geocoded were excluded.
Individuals younger than 16 years (n = 125) were excluded.
Tobacco use data were available for 2004–2010 only.
Patients with a self-reported or documented history of a diagnosis of TB infection or disease ≥ 12 months before the current TB diagnosis were defined as having a history of TB infection.
Percentage is among patients with extrapulmonary disease only. Categories are not exclusive because patients may have multiple extrapulmonary sites of disease.
Percentage is among those with an abnormal initial chest x-ray result.
Multidrug resistance was defined as resistance to at least isoniazid and rifampin.
Extensive drug resistance was defined as resistance to at least isoniazid and rifampin plus a fluoroquinolone and a second-line injectable TB medication. Percentage is among those with multidrug resistance.
Complete genotype was defined as a complete RFLP and spoligotype.
Patients with exactly matching RFLP and spoligotype results were considered clustered.
Percentage is among those with < 6 bands.
Percentage is among no. of patients investigated.
Percentage is among epidemiological links identified.