Area-Based Socio demographic Factors Associated with Latent Tuberculosis Infection in a Low-Prevalence Setting

Abstract

More than 1 million children and adolescents in the United States are estimated to have latent tuberculosis (TB) infection.1 For the most part, efforts to identify pediatric TB infection in the United States rely upon contact investigations and routine screening for TB risk factors,2 although ongoing incident pediatric TB disease in the United States highlights the limitations of these approaches. Researchers and public health authorities are increasingly interested in using administrative data that can be extrapolated from the electronic health record (EHR) to identify individuals at risk for TB infection.3 In particular, area-based markers of risk for TB infection may bypass some challenges with self-reported risk factors, which may be stigmatizing or purposefully omitted (e.g., immigration history)4 and subject to social desirability bias (e.g., language preference).5 Prior TB epidemiologic studies have used the proportion of foreign-born individuals in a census tract as a proxy for foreign-born status3,6 and have found pediatric TB disease prevalence to be associated with area poverty and demographic composition.7 However, the association between area-based sociodemographic factors and pediatric TB infection risk in the United States has not been vetted. In this study, we aimed to determine the relationship between area-based socio demographic factors and the likelihood of TB infection in a population of children tested for TB infection in an urban, low-burden setting.