title: Understanding the burden of tuberculosis among American Indians/Alaska Natives in the U.S.: a validation study.
abstract: OBJECTIVE
  We validated cases of active tuberculosis (TB) recorded in the Indian Health Service (IHS) National Patient Information Reporting System (NPIRS) and evaluated the completeness of TB case reporting from IHS facilities to state health departments.
  
  
  METHODS
  We reviewed the medical records of American Indian/Alaska Native (AI/AN) patients at IHS health facilities who were classified as having active TB using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes from 2006 to 2009 for clinical and laboratory evidence of TB disease. Individuals were reclassified as having active TB disease; recent latent TB infection (LTBI); past positive tuberculin skin test (TST) only; or as having no evidence of TB, LTBI, or a past positive TST. We compared validated active TB cases with corresponding state records to determine if they were reported.
  
  
  RESULTS
  The study included 596 patients with active TB as per ICD-9-CM codes. Based on chart review, 111 (18.6%) had active TB; 156 (26.2%) had LTBI; 104 (17.4%) had a past positive TST; and 221 (37.1%) had no evidence of TB disease, LTBI, or a past positive TST. Of the 111 confirmed cases of active TB, 89 (80.2%) resided in participating states; 81 of 89 (91.2%) were verified as reported TB cases.
  
  
  CONCLUSIONS
  ICD-9-CM codes for active TB disease in the IHS NPIRS do not accurately reflect the burden of TB among AI/ANs. Most confirmed active TB cases in the IHS health system were reported to the state; the national TB surveillance system may accurately represent the burden of TB in the AI/AN population.
authors: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
authors: Laura Jean
authors: LJ
authors: Podewils
authors: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA ; Emory University, Rollins School of Public Health, Atlanta, GA.
authors: Emily
authors: E
authors: Alexy
authors: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA ; Emory University, Rollins School of Public Health, Atlanta, GA.
authors: Stephani Jean
authors: SJ
authors: Driver
authors: Indian Health Service, Division of Epidemiology and Disease Prevention, Albuquerque, NM ; University of New Mexico Health Sciences Center, Albuquerque, NM.
authors: James E
authors: JE
authors: Cheek
authors: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Atlanta, GA.
authors: Robert C
authors: RC
authors: Holman
authors: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Atlanta, GA.
authors: Dana
authors: D
authors: Haberling
authors: Indian Health Service, Division of Epidemiology and Disease Prevention, Albuquerque, NM ; University of New Mexico Health Sciences Center, Albuquerque, NM.
authors: Meghan
authors: M
authors: Brett
authors: Indian Health Service, Santa Fe, NM.
authors: Eugene
authors: E
authors: McCray
authors: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Atlanta, GA ; Indian Health Service, Santa Fe, NM.
authors: John T
authors: JT
authors: Redd
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D007198:Indians, North American; D004930:Inuit; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult