title: Factors associated with unreported tuberculosis cases in Spanish hospitals.
abstract: BACKGROUND
  Under-reporting of tuberculosis (TB) cases complicates disease control, hinders contact tracing and alters the accuracy of epidemiological data, including disease burden. The objective of the present study is to evaluate the proportion of unreported TB cases in Spanish healthcare facilities and to identify the associated factors.
  
  
  METHODS
  A multi-center retrospective study design was employed. The study included TB cases diagnosed in 16 facilities during 2011-2012. These cases were compared to those reported to the corresponding public health departments. Demographic, microbiological and clinical data were analyzed to determine the factors associated with unreported cases. Associated factors were analyzed on a bivariate level using the x(2) test and on a multivariate level using a logistic regression. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated.
  
  
  RESULTS
  Of the 592 TB cases included in the study, 85 (14.4 %) were not reported. The percentage of unreported cases per healthcare center ranged from 0-45.2 %. The following variables were associated to under-reporting at a multivariate level: smear-negative TB (OR = 1.87; CI:1.07-3.28), extrapulmonary disease (OR = 2.07; CI:1.05-4.09) and retired patients (OR = 3.04; CI:1.29-7.18). A nurse case manager was present in all of the centers with 100 % reporting. The percentage of reported cases among the smear-positive cases was 9.4 % and 19.4 % (p = 0.001) among the rest of the study population. Smear-positive TB was no associated to under-reporting.
  
  
  CONCLUSIONS
  It is important that TB Control Programs encourage thorough case reporting to improve disease control, contact tracing and accuracy of epidemiological data. The help from a TB nurse case manager could improve the rate of under-reporting.
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. concepcionmorales@telefonica.net.|Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain. concepcionmorales@telefonica.net.
authors.forename: Concepción
authors.initials: C
authors.lastname: Morales-García
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. pii_tb_teresa_rodrigo@separ.es.|Fundación Respira de la SEPAR, Barcelona, Spain. pii_tb_teresa_rodrigo@separ.es.|Agencia de Salud Publica, Barcelona, Spain. pii_tb_teresa_rodrigo@separ.es.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodrigo
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. mgclemen@gmail.com.|Hospital Central de Asturias de Oviedo, Oviedo, Spain. mgclemen@gmail.com.
authors.forename: Marta M
authors.initials: MM
authors.lastname: García-Clemente
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. anamunozml@gmail.com.|Hospital Universitario Carlos Haya de Málaga, Malaga, Spain. anamunozml@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Muñoz
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. bermudezmp@gmail.com.|Hospital Universitario Carlos Haya de Málaga, Malaga, Spain. bermudezmp@gmail.com.
authors.forename: Pilar
authors.initials: P
authors.lastname: Bermúdez
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. franciscocasas@neumosur.net.|Hospital Universitario San Cecilio de Granada, Granada, Spain. franciscocasas@neumosur.net.
authors.forename: Francisco
authors.initials: F
authors.lastname: Casas
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. msomoza@cst.cat.|Consorcio Sanitario de Tarrasa, Barcelona, Spain. msomoza@cst.cat.
authors.forename: María
authors.initials: M
authors.lastname: Somoza
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. celia.mila@gmail.com.|Unitat de Prevenció i Control de Tuberculosis de Barcelona, Barcelona, Spain. celia.mila@gmail.com.
authors.forename: Celia
authors.initials: C
authors.lastname: Milá
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. anton.penas.truque@sergas.es.|Hospital Xeral-Calde de Lugo, Lugo, Spain. anton.penas.truque@sergas.es.
authors.forename: Antón
authors.initials: A
authors.lastname: Penas
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. chidalgo72@gmail.com.|Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain. chidalgo72@gmail.com.
authors.forename: Carmen
authors.initials: C
authors.lastname: Hidalgo
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. mcasals@aspb.es.|Agencia de Salud Publica, Barcelona, Spain. mcasals@aspb.es.
authors.forename: Martí
authors.initials: M
authors.lastname: Casals
authors.affiliation: Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain. jcayla@aspb.es.|Agencia de Salud Publica, Barcelona, Spain. jcayla@aspb.es.|CIBER de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain. jcayla@aspb.es.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylá
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018563:Disease Notification; D005260:Female; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D013030:Spain; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult