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Gender Differences in Early Suspicion of Tuberculosis in Hospitalized High-Risk Patients During 4 Epidemic Years, 1987 to 1990

Published online by Cambridge University Press:  02 January 2015

J. Peter Cegielski ,
Matthew B. Goetz ,
Jeffrey M. Jacobson ,
Susan E. Cohn ,
Robert A. Weinstein ,
Jack A. DeHovitz  and
Charles L. Bennett
J. Peter Cegielski*
Affiliation:
Center for Pulmonary Infectious Disease Control and Department of Medicine, University of Texas Health Center, Tyler, Texas
Matthew B. Goetz
Affiliation:
Department of Medicine, West Los Angeles Veterans' Administration Medical Center, Los Angeles, California
Jeffrey M. Jacobson
Affiliation:
Department of Medicine, Bronx Veterans' Administration Medical Center and Mount Sinai School of Medicine, New York City, New York
Susan E. Cohn
Affiliation:
Department of Medicine, University of Rochester, Rochester, New York
Robert A. Weinstein
Affiliation:
Department of Medicine, Rush Medical College and Cook County Hospital, Chicago, Illinois
Jack A. DeHovitz
Affiliation:
Department of Medicine, State University of New York Health Science Center, Brooklyn, New York
Charles L. Bennett
Affiliation:
Department of Medicine, Lakeside Veterans' Administration Medical Center and, Northwestern University, Chicago, Illinois, and RAND, Santa Monica, California
*
Johns Hopkins University, School of Hygiene and Public Health, Department of Epidemiology, 615 N Wolfe St, Room E-7132, Baltimore, MD 21205
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Abstract

Objectives:

To assess the degree to which, from 1987 to 1990, physicians suspected tuberculosis (TB) in the first 2 hospital days in human immunodeficiency virus (HIV)-infected patients with pulmonary disease.

Design:

Retrospective cohort study.

Setting:

96 hospitals in five US cities.

Patients:

2,174 adult patients with acquired immunodeficiency syndrome discharged with a diagnosis of Pneumocystis carinii pneumonia from 1987 to 1990. The diagnosis generally was not known on admission.

Results:

Physicians suspected TB in the first 2 hospital days in 66% of these patients in 1987, a rate that increased steadily to 74% in 1990. However, the extent to which physicians considered TB among female patients decreased from 76% to 71% over the 4 years. Controlling for confounding variables by multiple logistic regression, the odds that TB would be suspected early increased 1.8-fold among men (odds ratio [OR], 1.8; 95% confidence interval [CI95], 1.4-2.4), but not in women (OR, 0.6; CI95, 0.2-1.9). Among the five cities, the odds of early suspicion of TB increased most in New York City (OR, 3.9; CI95, 2.0-7.9).

Conclusions:

Physicians considered TB in a timely manner in an increasing majority of male, but not female, high-risk patients during the first years of TB resurgence in the United States. Physicians must be aware of the changing epidemiology of HIV and TB, as well as their practice patterns, to prevent nosocomial transmission of this disease

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 4 , April 1997 , pp. 237 - 243
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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