Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of Tuberculosis Disease Among Adult US-Bound Refugees with Chronic Kidney Disease

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

The association between chronic kidney disease (CKD) and tuberculosis disease (TB) has been recognized for decades. Recently CKD prevalence is increasing in low- to middle-income countries with high TB burden. Using data from the required overseas medical exam and the recommended US follow-up exam for 444,356 US-bound refugees aged ≥ 18 during 2009–2017, we ran Poisson regression to assess the prevalence of TB among refugees with and without CKD, controlling for sex, age, diabetes, tobacco use, body mass index ( kg/m2), prior residence in camp or non-camp setting, and region of birth country. Of the 1117 (0.3%) with CKD, 21 (1.9%) had TB disease; of the 443,239 who did not have CKD, 3380 (0.8%) had TB. In adjusted analyses, TB was significantly higher among those with than without CKD (prevalence ratio 1.93, 95% CI: 1.26, 2.98, p < 0.01). Healthcare providers attending to refugees need to be aware of this association.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pradhan RP, Katz LA, Nidus BD, Matalon R, Eisinger RP. Tuberculosis in dialyzed patients. Jama. 1974;229(7):798–800.

    Article  CAS  Google Scholar 

  2. Hsu HWLC, Wang MH, Chiang CK, Lu KC. A review of chronic kidney disease and the immune system: a special form of immunosenescence. J Gerontol Geriatr Res. 2014;3(2):1–6.

    Google Scholar 

  3. Kato S, Chmielewski M, Honda H, et al. Aspects of immune dysfunction in end-stage renal disease. Clin J Am Soc Nephrol. 2008;3(5):1526–33.

    Article  Google Scholar 

  4. Hossain MP, Goyder EC, Rigby JE, El Nahas M. CKD and poverty: a growing global challenge. Am J Kidney Dis. 2009;53(1):166–74.

    Article  Google Scholar 

  5. Waaler HT. Tuberculosis and poverty. Int J Tuberc Lung Dis. 2002;6(9):745–6.

    PubMed  Google Scholar 

  6. Weil EJ, Curtis JM, Hanson RL, Knowler WC, Nelson RG. The impact of disadvantage on the development and progression of diabetic kidney disease. Clin Nephrol. 2010;74(Suppl 1):32–8.

    Google Scholar 

  7. Centers for Disease Control and Prevention. National Chronic Kidney Disease Fact Sheet. 2017. https://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf. Accessed 11 June 2017.

  8. Bello AK, Levin A, Tonelli M, et al. Assessment of global kidney health care status. Jama. 2017;317(18):1864–81.

    Article  Google Scholar 

  9. Barsoum RS. Chronic kidney disease in the developing world. N Engl J Med. 2006;354(10):997–99.

    Article  CAS  Google Scholar 

  10. Romanowski K, Clark EG, Levin A, Cook VJ, Johnston JC. Tuberculosis and chronic kidney disease: an emerging global syndemic. Kidney Int. 2016;90(1):34–40.

    Article  Google Scholar 

  11. Ronald LA, Campbell JR, Balshaw RF, et al. Predicting tuberculosis risk in the foreign-born population of British Columbia, Canada: study protocol for a retrospective population-based cohort study. BMJ Open. 2016;6(11):e013488.

    Article  Google Scholar 

  12. Centers for Disease Control and Prevention. Technical instructions for panel physicians and civil surgeons. 2016; https://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/technical-instructions/panel-physicians/medical-history-physical-exam.html.

  13. Centers for Disease Control and Prevention. Disease surveillance among newly arriving refugees and immigrants — electronic disease notification system, United States. Morb Mortal Wkly Rep. 2009;62(2013):1–20.

    Google Scholar 

  14. United States Department of State. Countries Reg. 2017; https://www.state.gov/countries/. Accessed 11 Feb 2017.

  15. WHO, Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–163.

    Article  Google Scholar 

  16. Posey DL, Naughton MP, Willacy EA, et al. Implementation of new TB screening requirements for U.S.-bound immigrants and refugees–2007–2014. Morb Mortal Wkly Rep. 2014;63(11):234–6.

    Google Scholar 

  17. Benoit SR, Gregg EW, Jonnalagadda S, Phares CR, Zhou W, Painter JA. Association of diabetes and tuberculosis disease among US-bound adult refugees, 2009–2014. Emerg Infect Dis. 2017;23(3):543–5.

    Article  Google Scholar 

  18. Centers for Disease Control and Prevention. Tuberculosis screening and treatment technical instructions (TB TIs) using cultures and directly observed therapy (DOT) for panel physicians. 2013. https://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/tuberculosis-panel-technical-instructions.html. Accessed 08 Jan 2017.

  19. Levin A, et al. Kidney disease: improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1–150.

    Article  Google Scholar 

  20. Korn EL, Graubard BL. Analysis of health surveys. wiley series in probability and statistics. New York: Wiley; 1999.

    Google Scholar 

  21. Woeltje KF, Mathew A, Rothstein M, Seiler S, Fraser VJ. Tuberculosis infection and anergy in hemodialysis patients. Am J Kidney Dis. 1998;31(5):848–52.

    Article  CAS  Google Scholar 

  22. Hussein MM, Mooij JM, Roujouleh H. Tuberculosis and chronic renal disease. Semin Dial. 2003;16(1):38–44.

    Article  Google Scholar 

  23. Malik GH, Al-Harbi AS, Al-Mohaya S, et al. Eleven years of experience with dialysis associated tuberculosis. Clin Nephrol. 2002;58(5):356–62.

    Article  CAS  Google Scholar 

  24. Vandermarliere A, Van Audenhove A, Peetermans WE, Vanrenterghem Y, Maes B. Mycobacterial infection after renal transplantation in a Western population. Transpl Infect Dis. 2003;5(1):9–15.

    Article  CAS  Google Scholar 

  25. Chen CH, Lian JD, Cheng CH, Wu MJ, Lee WC, Shu KH. Mycobacterium tuberculosis infection following renal transplantation in Taiwan. Transpl Infect Dis. 2006;8(3):148–56.

    Article  Google Scholar 

  26. Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet. 2017;389(10072):951–63.

    Article  Google Scholar 

  27. Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5(7):e152.

    Article  Google Scholar 

  28. Riza AL, Pearson F, Ugarte-Gil C, et al. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. Lancet Diab Endocrinol. 2014;2(9):740–53.

    Article  Google Scholar 

  29. Bardenheier BH, Phares CR, Simpson D, et al. Trends in chronic diseases reported by refugees originating from burma resettling to the United States from camps versus urban areas during 2009–2016. J Immigr Minor Health. 2018 1–11.

  30. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737–46.

    Article  Google Scholar 

  31. World Health Organization. Tuberculosis Fact Sheet. 2017; http://www.who.int/mediacentre/factsheets/fs104/en/.

  32. Mallipattu SK, Salem F, Wyatt CM. The changing epidemiology of HIV-related chronic kidney disease in the era of antiretroviral therapy. Kidney Int. 2014;86(2):259–65.

    Article  Google Scholar 

  33. Centers for Disease and Prevention (CDC, and US Department of Health and Human Services. Medical examination of aliens–removal of human immunodeficiency virus (HIV) infection from definition of communicable disease of public health significance. Final rule. Fed Reg. 2009;74(210):56547–62.

    Google Scholar 

  34. World Health Organization. Global Status Report on Noncommunicable Diseases 2014. Geneva, Switzerland 2014.

  35. Cohn DL, et al. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med. 2000;161(4):221–47.

    Google Scholar 

Download references

Acknowledgements

This work was funded by the Department of Health and Human Services, Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors would like to thank Ms. Jenique Meekins for her help with editing.

Author information

Authors and Affiliations

  1. Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS E-03, 30333, Atlanta, GA, Georgia

    Barbara H. Bardenheier, Meda E. Pavkov, Carla A. Winston, Stephen Benoit, Drew L. Posey & Christina R. Phares

  2. International Organization for Migration, Washington, USA

    Alex Klosovsky & Catherine Yen

  3. Brown University, Providence, RI, USA

    Stefan Gravenstein

Authors
  1. Barbara H. Bardenheier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meda E. Pavkov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carla A. Winston
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alex Klosovsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catherine Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephen Benoit
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefan Gravenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Drew L. Posey
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christina R. Phares
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara H. Bardenheier.

Ethics declarations

Conflict of interest

Authors declare no conflicts of interest.

Informed Consent

No consent forms were needed.

Research involving Human and Animal Participants

All data used for this analysis were collected in the course of routine refugee resettlement practices. This project was determined to be non-research by a CDC human subjects advisor; IRB review was not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bardenheier, B.H., Pavkov, M.E., Winston, C.A. et al. Prevalence of Tuberculosis Disease Among Adult US-Bound Refugees with Chronic Kidney Disease. J Immigrant Minority Health 21, 1275–1281 (2019). https://doi.org/10.1007/s10903-018-00852-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-018-00852-8

Keywords

Search

Navigation