Sociodemographic Characteristics, Comorbidities, and Mortality Among Persons Diagnosed With Tuberculosis and COVID-19 in Close Succession in California, 2020 - PubMed (original) (raw)

. 2021 Dec 1;4(12):e2136853.

doi: 10.1001/jamanetworkopen.2021.36853.

Emily Han 1, Phil Lowenthal 1, Hannah Henry 1, Nnenna Okoye 1, Melony Chakrabarty 3, Amit S Chitnis 4, Ankita Kadakia 5, Elsa Villarino 6, Julie Low 7, Julie Higashi 8, Pennan M Barry 1, Seema Jain 1, Jennifer Flood 1

Affiliations

Sociodemographic Characteristics, Comorbidities, and Mortality Among Persons Diagnosed With Tuberculosis and COVID-19 in Close Succession in California, 2020

Scott A Nabity et al. JAMA Netw Open. 2021.

Abstract

Importance: Tuberculosis (TB) and COVID-19 are respiratory diseases that disproportionately occur among medically underserved populations; little is known about their epidemiologic intersection.

Objective: To characterize persons diagnosed with TB and COVID-19 in California.

Design, setting, and participants: This cross-sectional analysis of population-based public health surveillance data assessed the sociodemographic, clinical, and epidemiologic characteristics of California residents who were diagnosed with TB (including cases diagnosed and reported between September 3, 2019, and December 31, 2020) and COVID-19 (including confirmed cases based on positive results on polymerase chain reaction tests and probable cases based on positive results on antigen assays reported through February 2, 2021) in close succession compared with those who were diagnosed with TB before the COVID-19 pandemic (between January 1, 2017, and December 31, 2019) or diagnosed with COVID-19 alone (through February 2, 2021). This analysis included 3 402 713 California residents with COVID-19 alone, 6280 with TB before the pandemic, and 91 with confirmed or probable COVID-19 diagnosed within 120 days of a TB diagnosis (ie, TB/COVID-19).

Exposures: Sociodemographic characteristics, medical risk factors, factors associated with TB severity, and health equity index.

Main outcomes and measures: Frequency of reported successive TB and COVID-19 (TB/COVID-19) diagnoses within 120 days, frequency of deaths, and age-adjusted mortality rates.

Results: Among the 91 persons with TB/COVID-19, the median age was 58.0 years (range, 3.0-95.0 years; IQR, 41.0-73.0 years); 52 persons (57.1%) were male; 81 (89.0%) were born outside the US; and 28 (30.8%) were Asian or Pacific Islander, 4 (4.4%) were Black, 55 (60.4%) were Hispanic or Latino, 4 (4.4%) were White. The frequency of reported COVID-19 among those who received a TB diagnosis between September 3, 2019, and December 31, 2020, was 225 of 2210 persons (10.2%), which was similar to that of the general population (3 402 804 of 39 538 223 persons [8.6%]). Compared with persons with TB before the pandemic, those with TB/COVID-19 were more likely to be Hispanic or Latino (2285 of 6279 persons [36.4%; 95% CI, 35.2%-37.6%] vs 55 of 91 persons [60.4%; 95% CI, 49.6%-70.5%], respectively; P < .001), reside in low health equity census tracts (1984 of 6027 persons [32.9%; 95% CI, 31.7%-34.1%] vs 40 of 89 persons [44.9%; 95% CI, 34.4%-55.9%]; P = .003), live in the US longer before receiving a TB diagnosis (median, 19.7 years [IQR, 7.2-32.3 years] vs 23.1 years [IQR, 15.2-31.5 years]; P = .03), and have diabetes (1734 of 6280 persons [27.6%; 95% CI, 26.5%-28.7%] vs 42 of 91 persons [46.2%; 95% CI, 35.6%-56.9%]; P < .001). The frequency of deaths among those with TB/COVID-19 successively diagnosed within 30 days (8 of 34 persons [23.5%; 95% CI, 10.8%-41.2%]) was more than twice that of persons with TB before the pandemic (631 of 5545 persons [11.4%; 95% CI, 10.6%-12.2%]; P = .05) and 20 times that of persons with COVID-19 alone (42 171 of 3 402 713 persons [1.2%; 95% CI, 1.2%-1.3%]; P < .001). Persons with TB/COVID-19 who died were older (median, 81.0 years; IQR, 75.0-85.0 years) than those who survived (median, 54.0 years; IQR, 37.5-68.5 years; P < .001). The age-adjusted mortality rate remained higher among persons with TB/COVID-19 (74.2 deaths per 1000 persons; 95% CI, 26.2-122.1 deaths per 1000 persons) compared with either disease alone (TB before the pandemic: 56.3 deaths per 1000 persons [95% CI, 51.2-61.4 deaths per 1000 persons]; COVID-19 only: 17.1 deaths per 1000 persons [95% CI, 16.9-17.2 deaths per 1000 persons]).

Conclusions and relevance: In this cross-sectional analysis, TB/COVID-19 was disproportionately diagnosed among California residents who were Hispanic or Latino, had diabetes, or were living in low health equity census tracts. These results suggest that tuberculosis and COVID-19 occurring together may be associated with increases in mortality compared with either disease alone, especially among older adults. Addressing health inequities and integrating prevention efforts could avert the occurrence of concurrent COVID-19 and TB and potentially reduce deaths.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.

Figure 1.. Analytic Sample Selection for Persons With Tuberculosis (TB) and COVID-19

Includes persons in California diagnosed with TB between September 3, 2019, and December 31, 2020, who were also diagnosed with COVID-19.

Figure 2.

Figure 2.. Age-Stratified Frequency of Death

Frequency of death among California residents with COVID-19, tuberculosis (TB) before the COVID-19 pandemic, and both diseases successively diagnosed within 30, 60, 90, and 120 days in 2020. The frequency of death among persons with COVID-19 was calculated as 42 171 deaths among 3 402 713 persons diagnosed with COVID-19 as of February 2, 2021. Error bars represent Fisher exact 95% CIs for proportions. Tuberculosis cases were diagnosed and reported between September 3, 2019, and December 31, 2020. Persons with TB and COVID-19 included those with TB diagnoses reported through December 31, 2020, and COVID-19 diagnoses reported through February 2, 2021. Tuberculosis cases before the COVID-19 pandemic were reported from January 1, 2017, to December 31, 2019. One person was diagnosed with TB in December 2019 and COVID-19 in April 2020; this person was not included in the TB analysis group before the COVID-19 pandemic.

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