title: Trends in Tuberculosis Cases Among Nursing Home Residents, California, 2000 to 2009.
abstract: OBJECTIVE
  To examine trends in tuberculosis (TB) incidence and to compare demographic and clinical characteristics of nursing home (NH) residents and community-dwelling older adults.
  
  
  METHODS
  Prospective TB surveillance.
  
  
  METHODS
  TB cases reported in California from 2000 to 2009.
  
  
  METHODS
  TB patients aged 65 and older.
  
  
  METHODS
  Trends in TB incidence per 100,000 population were assessed using Poisson regression. Demographic and clinical characteristics were compared using the chi-square or Wilcoxon rank-sum test. Among NH residents, risk factors for death during TB treatment were identified using logistic regression.
  
  
  RESULTS
  From 2000 to 2009, TB incidence rates decreased significantly, from 15.9/100,000 to 8.4/100,000 (-44%, 95% confidence interval (CI) = -66% to -7%) for NH residents and from 21.2/100,000 to 15.0/100,000 (-27%, 95% CI = -29% to -24%) for community-dwelling older adults. Overall, 211 TB cases among NH residents and 6,518 cases among community-dwelling older adults were reported. NH residents were more likely than community-dwelling older adults to be older (median age 81 vs 75, P < .001), have a negative acid-fast bacilli sputum smear and positive culture (37% vs 28%, P < .001), and die while undergoing TB treatment (44% vs 14%, P < .001), and were less likely to have a positive tuberculin skin test (TST) (28% vs 44%, P < .001) and have TB care provided by a health department (20% vs 59%, P < .001). In multivariable analysis, NH residents who had a positive TST were less likely to die while undergoing TB treatment (odds ratio = 0.39, 95% CI = 0.16-0.96).
  
  
  CONCLUSIONS
  TB incidence rates were lower, and reductions in incidence were greater among NH residents; community-dwelling older adults had higher TB rates and smaller reductions in incidence. Interventions that promote timely detection and treatment of TB infection and disease may be needed to reduce morbidity and mortality among NH residents.
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
authors.forename: Amit S
authors.initials: AS
authors.lastname: Chitnis
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
authors.forename: Katherine
authors.initials: K
authors.lastname: Robsky
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
authors.forename: Gisela F
authors.initials: GF
authors.lastname: Schecter
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
authors.forename: Janice
authors.initials: J
authors.lastname: Westenhouse
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California.
authors.forename: Pennan M
authors.initials: PM
authors.lastname: Barry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002140:California / Q000453:epidemiology; D016358:Contact Tracing / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009735:Nursing Homes / Q000639:trends*; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*
keywords: epidemiology; incidence; nursing home; surveillance; tuberculosis