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首页> 外文期刊>Clinical infectious diseases >Differences in clinical presentation among persons with pulmonary tuberculosis: a comparison of documented and undocumented foreign-born versus US-born persons.
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Differences in clinical presentation among persons with pulmonary tuberculosis: a comparison of documented and undocumented foreign-born versus US-born persons.

机译：肺结核患者的临床表现差异：有证和无证外国出生者与美国出生者的比较。

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BACKGROUND: Most cases of tuberculosis (TB) in the United States are diagnosed in foreign-born persons, and undocumented foreign-born persons may face particular barriers to timely access to health care services. This study investigates whether differences in clinical presentations among persons with pulmonary TB are associated with foreign birth or documentation status. METHODS: In this cross-sectional study, we reviewed the medical records of patients who had received a diagnosis of microbiologically proven pulmonary TB at a New York City public hospital during the period April 1999 through March 2005. Three groups of patients with pulmonary TB (US-born persons, foreign-born persons with documents, and undocumented, foreign-born persons) were defined and compared at presentation. Odds ratios (ORs) for a symptom duration >or=8 weeks before hospital admission for each group were estimated using logistic regression. RESULTS: Among 194 subjects with newly diagnosed pulmonary TB, 61 (31%) were US born, 62(32%) were documented foreign-born persons, and 71 (37%) were undocumented foreign-born persons. Undocumented foreign-born persons presented with significantly higher frequencies of cough (P = .020) and hemoptysis P = .012 and had a significantly longer median duration of symptoms, compared with US-born persons (8 vs. 4 weeks; P = .023). No statistically significant differences between documented foreign-born and US-born persons were observed. Multivariate analysis revealed that undocumented status (compared with being US born; adjusted OR, 4.1; 95% confidence interval, 1.7-10.2; P = .0002) and being unemployed (adjusted OR, 2.2; 95% CI, 1.1-4.5; P = .023) were independently associated with a prolonged symptom duration (i.e., >or=8 weeks). CONCLUSIONS: Undocumented status was associated with an increased frequency of cough and hemoptysis and a longer duration of symptoms before medical evaluation for pulmonary TB. Whether reducing barriers to health services for undocumented foreign-born persons could enhanceTB control deserves additional study.
机译：背景：在美国，大多数结核病（TB）病例都是在外国出生的人中确诊的，而无证件的外国出生的人可能在及时获得医疗服务方面面临特殊的障碍。这项研究调查了肺结核患者之间临床表现的差异是否与外国出生或文献状态有关。方法：在这项横断面研究中，我们回顾了1999年4月至2005年3月在纽约市一家公立医院接受过微生物学证实的肺结核诊断的患者的病历。三组肺结核（在演示中定义并比较了美国出生的人，有文件的外国出生的人以及无证件的外国出生的人。使用logistic回归估计每组入院前症状持续时间≥8周的几率（OR）。结果：在194名新诊断的肺结核患者中，有61名（31％）在美国出生，有文件（62％（32％）为有证外国人），有71名（37％）为无证外国人。与美国出生的人相比，未记录的外国出生的人出现咳嗽的频率（P = .020）和咯血的频率显着更高（P = .012），并且中位症状的持续时间明显更长（8周比4周; P =。 023）。在有文件记录的外国出生的人和美国出生的人之间没有观察到统计学上的显着差异。多变量分析显示，无证件身份（与美国出生相比;调整后的OR为4.1; 95％置信区间为1.7-10.2; P = .0002）和失业（调整后的OR为2.2; 95％CI为1.1-4.5; P = .023）与症状持续时间延长（即，≥8周）独立相关。结论：在对肺结核进行医学​​评估之前，无证状态与咳嗽和咯血频率增加以及症状持续时间长有关。减少无证外国出生者的卫生服务障碍是否可以增强结核病控制值得进一步研究。

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