title: Tuberculosis misclassification among resettled refugees in Buffalo, New York, USA.
abstract: BACKGROUND
  Discordance in the classification of tuberculosis (TB) disease overseas compared to classification in the United States has been observed among immigrant populations.
  
  
  OBJECTIVE
  To examine TB misclassification among recently resettled refugees in Buffalo, NY, between 2005 and 2012.
  
  
  METHODS
  Retrospective study of refugees resettled to Buffalo from 2005 to 2012 and evaluated at a refugee/community health center. Centers for Disease Control and Prevention (CDC) Division of Global Migration and Quarantine (DGMQ) Class B1-B3 and American Thoracic Society (ATS) Class 2 (LTBI) cases were abstracted. Independent variables were demographics, countries of origin and refugee camp internment, year of resettlement, purified protein derivative induration, and chest X-ray findings, while CDC DGMQ and ATS classification were dependent variables. Independent samples t-test and analysis of variance were performed.
  
  
  RESULTS
  Of 284 charts reviewed, 233 (81.2%) were misclassified. Among 101 cases of LTBI (B1/B2) diagnosed outside the United States, 51 (50.5%) were overdiagnosed. Underdiagnoses occurred among 181/182 refugees (99.5%) originally classified as normal overseas.
  
  
  CONCLUSIONS
  These findings suggest that TB misclassification among recent immigrants remains widespread. Screening procedures both before and after resettlement should be better synchronized. Public health implications range from morbidity and costs of unnecessary treatment to the spread of a highly communicable disease.
authors.affiliation: Department of Social & Preventive Medicine, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, New York, USA.
authors.forename: T B
authors.initials: TB
authors.lastname: Evans
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo and Western New York Veterans Affairs Healthcare System Buffalo Veterans Affairs Medical Center, Buffalo, New York, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mador
authors.affiliation: Jericho Road Community Health Center, Buffalo, New York, USA.
authors.forename: M
authors.initials: M
authors.lastname: Glick
authors.affiliation: Department of Social & Preventive Medicine, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, New York, USA.
authors.forename: I
authors.initials: I
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014376:Tuberculosis / Q000145:classification / Q000175:diagnosis*; D055815:Young Adult