Table 3. Results of two logistic regression models which examine associations between insurance enrollee characteristics and screening for Mycobacterium tuberculosis with either a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA) between 2011 and 2013, based on data from the Optum Clinformatics Data Mart Database (N = 3,997,986).
| Model #1: Includes Individual Clinical Risk Factors | Model #2: Includes a Count of Clinical Risk Factors | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Odds Ratio | P-value | 99.9% Confidence Interval | Average Adjusted Prob-ability* | 99.9% Confidence Interval | Odds Ratio | P-value | 99.9% Confidence Interval | Average Adjusted Prob-ability* | 99.9% Confidence Interval | ||||||
| Sex | Female | 1.00 | 5.1% | 5.1% | 5.2% | 1.00 | 5.2% | 5.2% | 5.3% | ||||||
| Male | 0.65 | <.001 | 0.63 | 0.66 | 3.5% | 3.5% | 3.5% | 0.63 | <.001 | 0.62 | 0.64 | 3.4% | 3.4% | 3.5% | |
| Age | 0–4 | 1.00 | 9.0% | 8.8% | 9.2% | 1.00 | 9.7% | 9.5% | 10.0% | ||||||
| 5–9 | 0.55 | <.001 | 0.53 | 0.57 | 5.4% | 5.3% | 5.6% | 0.55 | <.001 | 0.53 | 0.57 | 5.8% | 5.6% | 5.9% | |
| 10–14 | 0.57 | <.001 | 0.55 | 0.59 | 5.6% | 5.5% | 5.7% | 0.57 | <.001 | 0.55 | 0.59 | 5.9% | 5.8% | 6.1% | |
| 15–19 | 1.47 | <.001 | 1.42 | 1.52 | 12.4% | 12.2% | 12.5% | 1.41 | <.001 | 1.36 | 1.46 | 12.9% | 12.7% | 13.1% | |
| 20–24 | 0.93 | <.001 | 0.89 | 0.96 | 8.5% | 8.3% | 8.6% | 0.87 | <.001 | 0.84 | 0.90 | 8.7% | 8.5% | 8.8% | |
| 25–29 | 0.30 | <.001 | 0.28 | 0.31 | 3.2% | 3.0% | 3.3% | 0.29 | <.001 | 0.28 | 0.31 | 3.2% | 3.1% | 3.3% | |
| 30–34 | 0.30 | <.001 | 0.29 | 0.31 | 3.2% | 3.1% | 3.3% | 0.29 | <.001 | 0.28 | 0.31 | 3.2% | 3.1% | 3.3% | |
| 35–39 | 0.28 | <.001 | 0.26 | 0.29 | 3.0% | 2.9% | 3.1% | 0.27 | <.001 | 0.26 | 0.28 | 3.0% | 2.9% | 3.1% | |
| 40–44 | 0.25 | <.001 | 0.24 | 0.26 | 2.7% | 2.6% | 2.8% | 0.24 | <.001 | 0.23 | 0.25 | 2.7% | 2.6% | 2.8% | |
| 45–49 | 0.21 | <.001 | 0.20 | 0.22 | 2.3% | 2.2% | 2.4% | 0.20 | <.001 | 0.20 | 0.21 | 2.3% | 2.2% | 2.4% | |
| 50–54 | 0.19 | <.001 | 0.18 | 0.20 | 2.1% | 2.0% | 2.2% | 0.18 | <.001 | 0.17 | 0.19 | 2.0% | 1.9% | 2.1% | |
| 55–59 | 0.18 | <.001 | 0.17 | 0.19 | 2.0% | 1.9% | 2.1% | 0.17 | <.001 | 0.16 | 0.18 | 1.9% | 1.8% | 1.9% | |
| 60–64 | 0.16 | <.001 | 0.15 | 0.17 | 1.8% | 1.7% | 1.9% | 0.15 | <.001 | 0.14 | 0.16 | 1.7% | 1.6% | 1.7% | |
| Census Division | New England | 1.00 | 3.5% | 3.4% | 3.6% | 1.00 | 3.4% | 3.3% | 3.5% | ||||||
| Mid-Atlantic | 1.96 | <.001 | 1.89 | 2.03 | 6.3% | 6.2% | 6.4% | 1.98 | <.001 | 1.91 | 2.05 | 6.4% | 6.3% | 6.5% | |
| East North Central | 1.51 | <.001 | 1.44 | 1.58 | 5.0% | 4.9% | 5.1% | 1.50 | <.001 | 1.44 | 1.57 | 5.0% | 4.8% | 5.1% | |
| West North Central | 1.19 | <.001 | 1.13 | 1.25 | 4.1% | 3.9% | 4.2% | 1.19 | <.001 | 1.13 | 1.24 | 4.0% | 3.9% | 4.1% | |
| South Atlantic | 1.06 | <.001 | 1.02 | 1.10 | 3.7% | 3.6% | 3.7% | 1.08 | <.001 | 1.03 | 1.12 | 3.7% | 3.6% | 3.7% | |
| East South Central | 1.13 | <.001 | 1.06 | 1.21 | 3.9% | 3.7% | 4.1% | 1.14 | <.001 | 1.06 | 1.22 | 3.8% | 3.6% | 4.1% | |
| West South Central | 0.70 | <.001 | 0.67 | 0.74 | 2.5% | 2.5% | 2.6% | 0.72 | <.001 | 0.69 | 0.75 | 2.5% | 2.4% | 2.6% | |
| Mountain | 1.06 | .001 | 1.00 | 1.13 | 3.7% | 3.5% | 3.8% | 1.08 | <.001 | 1.02 | 1.15 | 3.7% | 3.5% | 3.8% | |
| Pacific | 1.47 | <.001 | 1.40 | 1.55 | 4.9% | 4.8% | 5.0% | 1.48 | <.001 | 1.41 | 1.55 | 4.9% | 4.7% | 5.0% | |
| Rural-Urban Continuum Category | Large central metro (Most urban & densely populated) | 1.00 | 4.3% | 4.2% | 4.4% | 1.00 | 4.3% | 4.3% | 4.4% | ||||||
| Large fringe metro | 1.05 | <.001 | 1.02 | 1.08 | 4.5% | 4.4% | 4.6% | 1.04 | <.001 | 1.02 | 1.07 | 4.5% | 4.4% | 4.6% | |
| Medium metro | 1.00 | .964 | 0.97 | 1.03 | 4.3% | 4.2% | 4.4% | 0.98 | .022 | 0.95 | 1.01 | 4.3% | 4.2% | 4.3% | |
| Small metro | 0.86 | <.001 | 0.82 | 0.90 | 3.8% | 3.6% | 3.9% | 0.84 | <.001 | 0.80 | 0.88 | 3.7% | 3.6% | 3.9% | |
| Micropolitan | 0.80 | <.001 | 0.76 | 0.85 | 3.5% | 3.4% | 3.7% | 0.78 | <.001 | 0.74 | 0.82 | 3.5% | 3.3% | 3.6% | |
| Noncore (Most rural & least populated) | 0.81 | <.001 | 0.75 | 0.87 | 3.6% | 3.3% | 3.8% | 0.79 | <.001 | 0.73 | 0.84 | 3.5% | 3.3% | 3.7% | |
| PCP Health Professional Shortage Area | Not an HPSA | 1.00 | 4.3% | 4.3% | 4.3% | 1.00 | 4.3% | 4.3% | 4.4% | ||||||
| HPSA | 0.93 | <.001 | 0.87 | 0.99 | 4.0% | 3.8% | 4.3% | 0.92 | <.001 | 0.86 | 0.98 | 4.0% | 3.8% | 4.2% | |
| Insurance Type | HMO | 1.00 | 4.2% | 4.1% | 4.3% | 1.00 | 4.2% | 4.1% | 4.3% | ||||||
| Indemnity | 0.76 | .110 | 0.43 | 1.34 | 3.3% | 1.6% | 4.9% | 0.73 | .068 | 0.42 | 1.29 | 3.1% | 1.5% | 4.8% | |
| POS | 1.03 | <.001 | 1.00 | 1.06 | 4.3% | 4.3% | 4.3% | 1.02 | .005 | 1.00 | 1.05 | 4.3% | 4.2% | 4.3% | |
| PPO | 1.09 | <.001 | 1.06 | 1.12 | 4.5% | 4.4% | 4.6% | 1.10 | <.001 | 1.07 | 1.13 | 4.6% | 4.5% | 4.6% | |
| Percent of Households in County with Income under FPL*** | 1.00 | .004 | 1.00 | 1.00 | ** | ** | ** | 1.00 | .001 | 1.00 | 1.00 | ** | ** | ** | |
| Percent of Foreign-born Individuals in County*** | 1.02 | <.001 | 1.02 | 1.02 | ** | ** | ** | 1.02 | <.001 | 1.02 | 1.02 | ** | ** | ** | |
| State TB Rate per 100,000**** | 1.18 | <.001 | 1.17 | 1.19 | ** | ** | ** | 1.18 | <.001 | 1.16 | 1.19 | ** | ** | ** | |
| Asthma | No diagnosis | 1.00 | 4.2% | 4.2% | 4.3% | 1.00 | 4.2% | 4.2% | 4.3% | ||||||
| Had diagnosis | 1.31 | <.001 | 1.26 | 1.35 | 5.3% | 5.2% | 5.5% | 1.27 | <.001 | 1.23 | 1.31 | 5.3% | 5.1% | 5.4% | |
| COPD | No diagnosis | 1.00 | 4.3% | 4.3% | 4.3% | 1.00 | 4.3% | 4.3% | 4.3% | ||||||
| Had diagnosis | 1.48 | <.001 | 1.36 | 1.62 | 6.0% | 5.6% | 6.5% | 1.16 | <.001 | 1.06 | 1.25 | 4.9% | 4.5% | 5.3% | |
| Count of Clinical Risk Factors | 0 clinical risk factors | N/A | N/A | N/A | N/A | 1.000 | 3.8% | 3.8% | 3.8% | ||||||
| 1 clinical risk factor | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 2.82 | <.001 | 2.75 | 2.89 | 9.4% | 9.2% | 9.6% | |
| 2 clinical risk factors | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 4.23 | <.001 | 4.01 | 4.45 | 13.0% | 12.5% | 13.5% | |
| 3 clinical risk factors | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 4.91 | <.001 | 4.41 | 5.47 | 14.6% | 13.4% | 15.8% | |
| 4 clinical risk factors | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 9.70 | <.001 | 7.35 | 12.80 | 23.6% | 19.3% | 27.8% | |
| > = 5 clinical risk factors | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 18.51 | <.001 | 9.39 | 36.49 | 34.8% | 21.8% | 47.7% | |
| HIV | No diagnosis | 1.00 | 4.3% | 4.2% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 11.02 | <.001 | 10.05 | 12.08 | 26.7% | 25.2% | 28.2% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Immuno-supressive Medications | No medication/ procedure | 1.00 | 4.0% | 4.0% | 4.1% | N/A | N/A | N/A | N/A | ||||||
| Had medication/ procedure | 17.51 | <.001 | 16.79 | 18.26 | 34.4% | 33.7% | 35.2% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Diagnosis of Contact with TB | No diagnosis | 1.00 | 4.2% | 4.2% | 4.2% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 108.88 | <.001 | 97.05 | 122.14 | 71.6% | 69.6% | 73.7% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| History/Late Effects of TB | No diagnosis | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 4.47 | <.001 | 3.22 | 6.19 | 14.5% | 11.0% | 18.0% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Diabetes | No diagnosis/ medication | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis/ medication | 1.15 | <.001 | 1.10 | 1.20 | 4.8% | 4.7% | 5.0% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Tobacco | No diagnosis/ medication | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis/ medication | 1.12 | <.001 | 1.07 | 1.18 | 4.7% | 4.5% | 4.9% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Leukemia or Lymphoma | No diagnosis | 1.00 | 4.3% | 4.3% | 4.4% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 0.55 | <.001 | 0.46 | 0.64 | 2.5% | 2.2% | 2.9% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Lung Cancer | No diagnosis | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 1.35 | .001 | 0.99 | 1.84 | 5.6% | 4.1% | 7.0% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Head or Neck Cancer | No diagnosis | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 1.01 | .923 | 0.71 | 1.44 | 4.4% | 3.0% | 5.7% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Lung Disease Due to External Agents | No diagnosis | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 1 800 | <.001 | 1.04 | 3.13 | 7.1% | 3.8% | 10.4% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Gastrectomy or Gastric Bypass | No diagnosis/ procedure | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis/ procedure | 1.31 | <.001 | 1.16 | 1.49 | 5.4% | 4.9% | 6.0% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| ESRD/Dialysis | No diagnosis | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 1.40 | <.001 | 1.22 | 1.60 | 5.7% | 5.1% | 6.4% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Alcohol Use Disorder | No diagnosis | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 1.29 | <.001 | 1.17 | 1.41 | 5.3% | 4.9% | 5.8% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Drug Use Disorder | No diagnosis | 1.00 | 4.3% | 4.3% | 4.3% | N/A | N/A | N/A | N/A | ||||||
| Had diagnosis | 1.06 | .020 | 0.98 | 1.16 | 4.5% | 4.2% | 4.9% | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
* Calculated as the average predicted probability of a test conditional on all observations being in the category represented by the row. The difference between the predicted probabilities for two categories of a given categorical variable represents the average marginal effect.
** The percent of households in county with income under FPL, percent of foreign-born individuals in county, and the state TB rate were entered into the models as continuous variables. Average predicted probability of Mycobacterium tuberculosis screening at the minimum, maximum, and quartile values of these variables can be found in Table 4.
*** Unit of increase is 1 per cent.
**** Unit of increase is 1 per 100,000.
Abbreviations:
TST = tuberculin skin test
IGRA = interferon-gamma release assay
PCP = primary care provider
TB = tuberculosis
FPL = federal poverty level
COPD = chronic obstructive pulmonary disease
HIV = human immunodeficiency virus
ESRD = end stage renal disease
HMO = health maintenance organization
PPO = preferred provider organization
POS = place of service