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Sociodemographic Characteristics, Comorbidities, and Mortality Among Persons Diagnosed With Tuberculosis and COVID-19 in Close Succession in California, 2020

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the sociodemographic, clinical, and epidemiologic characteristics of persons diagnosed with tuberculosis (TB) and COVID-19 in close succession in California?

Findings  In this cross-sectional analysis of public health surveillance records from California residents, 91 individuals diagnosed with TB and COVID-19 more commonly had Hispanic or Latino ethnicity, diabetes, and residence in a low health equity census tract compared with those who received a TB diagnosis before the COVID-19 pandemic. Mortality rates among those diagnosed with TB and COVID-19 in close succession were higher than mortality rates among those with TB before the COVID-19 pandemic and those with COVID-19 alone.

Meaning  The findings of this analysis suggest that addressing long-standing health inequities and integrating prevention measures for COVID-19 and TB in California may reduce the co-occurrence of these diseases and prevent deaths.

Abstract

Importance  Tuberculosis (TB) and COVID-19 are respiratory diseases that disproportionately occur among medically underserved populations; little is known about their epidemiologic intersection.

Objective  To characterize persons diagnosed with TB and COVID-19 in California.

Design, Setting, and Participants  This cross-sectional analysis of population-based public health surveillance data assessed the sociodemographic, clinical, and epidemiologic characteristics of California residents who were diagnosed with TB (including cases diagnosed and reported between September 3, 2019, and December 31, 2020) and COVID-19 (including confirmed cases based on positive results on polymerase chain reaction tests and probable cases based on positive results on antigen assays reported through February 2, 2021) in close succession compared with those who were diagnosed with TB before the COVID-19 pandemic (between January 1, 2017, and December 31, 2019) or diagnosed with COVID-19 alone (through February 2, 2021). This analysis included 3 402 713 California residents with COVID-19 alone, 6280 with TB before the pandemic, and 91 with confirmed or probable COVID-19 diagnosed within 120 days of a TB diagnosis (ie, TB/COVID-19).

Exposures  Sociodemographic characteristics, medical risk factors, factors associated with TB severity, and health equity index.

Main Outcomes and Measures  Frequency of reported successive TB and COVID-19 (TB/COVID-19) diagnoses within 120 days, frequency of deaths, and age-adjusted mortality rates.

Results  Among the 91 persons with TB/COVID-19, the median age was 58.0 years (range, 3.0-95.0 years; IQR, 41.0-73.0 years); 52 persons (57.1%) were male; 81 (89.0%) were born outside the US; and 28 (30.8%) were Asian or Pacific Islander, 4 (4.4%) were Black, 55 (60.4%) were Hispanic or Latino, 4 (4.4%) were White. The frequency of reported COVID-19 among those who received a TB diagnosis between September 3, 2019, and December 31, 2020, was 225 of 2210 persons (10.2%), which was similar to that of the general population (3 402 804 of 39 538 223 persons [8.6%]). Compared with persons with TB before the pandemic, those with TB/COVID-19 were more likely to be Hispanic or Latino (2285 of 6279 persons [36.4%; 95% CI, 35.2%-37.6%] vs 55 of 91 persons [60.4%; 95% CI, 49.6%-70.5%], respectively; P < .001), reside in low health equity census tracts (1984 of 6027 persons [32.9%; 95% CI, 31.7%-34.1%] vs 40 of 89 persons [44.9%; 95% CI, 34.4%-55.9%]; P = .003), live in the US longer before receiving a TB diagnosis (median, 19.7 years [IQR, 7.2-32.3 years] vs 23.1 years [IQR, 15.2-31.5 years]; P = .03), and have diabetes (1734 of 6280 persons [27.6%; 95% CI, 26.5%-28.7%] vs 42 of 91 persons [46.2%; 95% CI, 35.6%-56.9%]; P < .001). The frequency of deaths among those with TB/COVID-19 successively diagnosed within 30 days (8 of 34 persons [23.5%; 95% CI, 10.8%-41.2%]) was more than twice that of persons with TB before the pandemic (631 of 5545 persons [11.4%; 95% CI, 10.6%-12.2%]; P = .05) and 20 times that of persons with COVID-19 alone (42 171 of 3 402 713 persons [1.2%; 95% CI, 1.2%-1.3%]; P < .001). Persons with TB/COVID-19 who died were older (median, 81.0 years; IQR, 75.0-85.0 years) than those who survived (median, 54.0 years; IQR, 37.5-68.5 years; P < .001). The age-adjusted mortality rate remained higher among persons with TB/COVID-19 (74.2 deaths per 1000 persons; 95% CI, 26.2-122.1 deaths per 1000 persons) compared with either disease alone (TB before the pandemic: 56.3 deaths per 1000 persons [95% CI, 51.2-61.4 deaths per 1000 persons]; COVID-19 only: 17.1 deaths per 1000 persons [95% CI, 16.9-17.2 deaths per 1000 persons]).

Conclusions and Relevance  In this cross-sectional analysis, TB/COVID-19 was disproportionately diagnosed among California residents who were Hispanic or Latino, had diabetes, or were living in low health equity census tracts. These results suggest that tuberculosis and COVID-19 occurring together may be associated with increases in mortality compared with either disease alone, especially among older adults. Addressing health inequities and integrating prevention efforts could avert the occurrence of concurrent COVID-19 and TB and potentially reduce deaths.

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Article Information

Accepted for Publication: September 22, 2021.

Published: December 3, 2021. doi:10.1001/jamanetworkopen.2021.36853

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Nabity SA et al. JAMA Network Open.

Corresponding Author: Scott A. Nabity, MD, MPH, California Department of Public Health, 850 Marina Bay Pkwy, Bldg P, 2nd Floor, Richmond, CA 94804 (scott.nabity@cdph.ca.gov).

Author Contributions: Dr Nabity and Ms Han had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Nabity and Ms Han contributed equally.

Concept and design: Nabity, Han, Lowenthal, Chitnis, Kadakia, Villarino, Higashi, Barry, Jain, Flood.

Acquisition, analysis, or interpretation of data: Nabity, Han, Henry, Okoye, Chakrabarty, Chitnis, Kadakia, Villarino, Low, Higashi, Barry, Jain, Flood.

Drafting of the manuscript: Nabity, Han, Villarino, Higashi, Jain.

Critical revision of the manuscript for important intellectual content: Han, Lowenthal, Henry, Okoye, Chakrabarty, Chitnis, Kadakia, Low, Higashi, Barry, Jain, Flood.

Statistical analysis: Nabity, Han, Lowenthal, Henry.

Obtained funding: Jain.

Administrative, technical, or material support: Henry, Chakrabarty, Chitnis, Barry, Jain, Flood.

Supervision: Barry, Jain, Flood.

Conflict of Interest Disclosures: None reported.

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