Last data update: May 13, 2024. (Total: 46773 publications since 2009)
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Query Trace: Winston CT[original query] |
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Increasing proportions of advanced pulmonary tuberculosis in the United States: are delays in diagnosis on the rise?
Wallace RM , Kammerer JS , Iademarco MF , Althomsons SP , Winston CT , Navin TR . Am J Respir Crit Care Med 2009 180 (10) 1016-22 INTRODUCTION: Delays in the diagnosis of tuberculosis can result in progression to advanced disease. Pulmonary tuberculosis patients with advanced disease are more likely to transmit disease and fail treatment. METHODS: Pulmonary tuberculosis cases in persons >15 years of age reported to the U.S. National Tuberculosis Surveillance System with advanced disease (cavitation on chest radiograph and acid-fast-bacilli smear-positive sputum result) were compared with those without advanced disease using trend and binomial regression analysis. RESULTS: There were 35,584 cases of advanced pulmonary tuberculosis (APT) and 125,077 cases of non-APT reported from 1993 through 2006. Proportions of pulmonary tuberculosis cases with APT increased from 18.5% in 1993 to 26.1% in 2006, and the increase in the proportion of APT was most notable for national tuberculosis rates below 6.6 per 100,000. At the county level, the association between APT and low tuberculosis incidence has grown incrementally stronger since 2000. The proportion of APT increased greatest among whites (65.4%), the employed (63.3%), and the U.S. born (59.2%). The prevalence of APT was 44% greater among persons with multidrug-resistant tuberculosis compared to those without it. CONCLUSION: This study highlights the need for tuberculosis diagnosis at early stages of the disease to minimize APT and decrease the risk of transmission. Additional efforts should concentrate on reducing time to treatment initiation in low-incidence areas and among groups traditionally seen as being at low-risk for tuberculosis disease. |
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