title: Latent Tuberculosis Infection Test Agreement in the National Health and Nutrition Examination Survey.
abstract: Latent tuberculosis infection (LTBI) test discordance is poorly understood.
  
  
  
  To determine the frequency and predictors of tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT) discordance in the U.S.
  
  
  
  We analyzed data from a representative sample of the U.S. population ages 6 years and older who participated in the 2011-2012 National Health and Nutrition Examination Survey. We determined prevalence estimates of test positivity, calculated test agreement and kappa statistics, and performed multivariable logistic regression to determine predictors of discordance.
  
  
  
  LTBI prevalence among the U.S. born ranged from 0.6% to 2.8%, depending on how LTBI was defined, with test agreement 97.0% and kappa 0.27 (95% confidence interval, 0.18-0.36). Prevalence among the foreign born ranged from 9.1% to 20.3%, depending on how LTBI was defined, with test agreement 81.6% and kappa 0.38 (95% confidence interval, 0.33-0.44). TST(+)/QFT(-) discordance was associated with age, male sex, black race, Mexican-American ethnicity, previous TB exposure, and past LTBI treatment in U.S.-born participants, but only with higher lymphocyte count in foreign-born participants. TST(-)/QFT(+) discordance was associated with older age, previous TB exposure, and past LTBI treatment in U.S.-born participants and with older age, male sex, and past LTBI treatment in foreign-born participants.
  
  
  
  In the largest population-based sample of concurrently performed TST and QFT tests in a low tuberculosis incidence population, prevalence estimates depended heavily on how LTBI was defined and test agreement was only fair. We identified several predictors of discordance warranting further study.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Ghassemieh
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
authors.forename: Engi F
authors.initials: EF
authors.lastname: Attia
authors.affiliation: 2 Division of Allergy and Infectious Diseases, Department of Medicine.|3 Department of Laboratory Medicine.|5 Department of Global Health, and.|4 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: David M
authors.initials: DM
authors.lastname: Koelle
authors.affiliation: 6 Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and.
authors.forename: James D
authors.initials: JD
authors.lastname: Mancuso
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.|7 Firland Northwest Tuberculosis Center, University of Washington, Seattle, Washington.|8 TB Control Program, Public Health - Seattle & King County, Seattle, Washington.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Narita
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.|5 Department of Global Health, and.|7 Firland Northwest Tuberculosis Center, University of Washington, Seattle, Washington.
authors.forename: David J
authors.initials: DJ
authors.lastname: Horne
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D002648:Child; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000379:methods / Q000706:statistics & numerical data*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D015203:Reproducibility of Results; D017678:Sex Distribution; D014374:Tuberculin Test / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: United States; epidemiology; latent tuberculosis; test discordance