Association Between Birth Region and Time to Tuberculosis Diagnosis After US Entry Among Non−US-Born Persons

Approximately 90% of US tuberculosis (TB) cases among non−US-born persons are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated if birthplace is associated with time of progression to TB disease among non−US-born persons. We derived a Cox regression model comparing differences in time to TB diagnosis after US entry among 19 global birth regions, adjusting for sex, birth year, and age at diagnosis. Compared with persons from Western Europe, the adjusted hazard rate of developing TB was significantly higher (p≤0.05) for persons from all other regions, except North America and Northern Europe, and highest among persons from Middle Africa (adjusted hazard ratio = 7.0; 95% confidence interval: 6.5−7.4). Time to TB diagnosis among non−US-born persons therefore varied by birth region, which represents an important prognostic indicator for progression to TB disease. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Neither the authors nor their institutions at any time received payment or services from a third party for any aspect of the submitted work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All data were collected as part of routine disease surveillance and were not part of human subjects research requiring institutional review board approval. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data contain information abstracted from the national tuberculosis case report form called the Report of Verified Case of Tuberculosis (RVCT) (OMB No. 0920-0026). These data have been reported voluntarily to CDC by state and local health departments, and are protected under the Assurance of Confidentiality (Sections 306 and 308(d) of the Public Health Service Act, 42 U.S.C. 242k and 242m(d)), which prevents disclosure of any information that could be used to directly or indirectly identify patients. For more information, see the CDC/ATSDR Policy on Releasing and Sharing Data (http://www.cdc.gov/maso/Policy/ReleasingData.pdf). A limited dataset is available at http://wonder.cdc.gov/TB.html. Researchers seeking additional data may apply to analyze National Tuberculosis Surveillance System data at CDC headquarters by contacting the Division of Tuberculosis Elimination (TBinfo@cdc.gov).