488. Trends in Tuberculosis Incidence among Nursing Home Residents, California, 2000-2009
Session: Poster Abstract Session: Public Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C

Background: Rates of tuberculosis (TB) disease among nursing home residents have been reported as twice that among elderly persons in the general population. In California, screening for latent TB infection (LTBI) is recommended upon admission to a long-term care facility and annually. No studies have evaluated trends in TB in nursing home residents. We examined 10-year TB trends among California nursing home residents.

Methods: We analyzed California TB registry data for cases reported during 20002009. Estimates of nursing home residents and the overall population were obtained from Centers for Medicare and Medicaid Services and California Department of Finance. We used Poisson regression to analyze trends in TB incidence and weighted linear regression to analyze trends in the proportion of TB cases diagnosed in nursing homes.

Results: Of 29,564 TB cases reported in California during 20002009, 260 (0.9%) were residents of a nursing home at the time of diagnosis. Among all TB cases, 6885 (23%) were aged 65 years or older compared to 211 (81%) of cases among nursing home residents. In this age group, TB incidence decreased both overall (-28%, 95% confidence interval [CI]: -30%, -25%) and among nursing home residents (-44%, CI: -66%, -7%) and was consistently lower among nursing home residents compared to the overall TB rate (Figure). TB incidence in nursing home residents of all ages decreased among males (-62%, CI: -78%, -33%), Asian/Pacific Islanders (-59%, CI: -81%, -8%), non-Hispanic blacks (-72%, CI: -91%,-15%), and residents aged 65-84 years (-55%, CI:-76%, -13%). No change was seen in the proportion of TB cases aged 65 years or older diagnosed in nursing homes (p=0.30).

Conclusion: During 20002009, TB incidence declined among nursing home residents and overall in California. TB incidence was lower among nursing home residents than overall TB incidence among the population of similar age, differing from previously reported rates in these populations. Routine screening and treatment for LTBI in long-term care facilities may be preventing TB cases in this population, explaining the observed declines and differences. This finding provides indirect evidence that supports ongoing screening and treatment for LTBI among nursing home residents.



Figure: Incidence of TB in California and Nursing Homes among Persons Aged 65 Years and Older, 2000-2009


Katherine Robsky, MPH, Amit Chitnis, MD, MPH, Gisela Schecter, MD, MPH and Pennan Barry, MD, MPH, Tuberculosis Control Branch, California Department of Public Health, Richmond, CA


K. Robsky, None

A. Chitnis, None

G. Schecter, None

P. Barry, None

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