摘要：Objectives. We have described the characteristics of South Asian-born tuberculosis (TB) patients living in New York City (NYC) and compared them with other foreign-born patients to explore possible explanations for the disproportionate burden of TB in the South Asian population. Methods. We used data on demographic and clinical characteristics for TB patients identified by the NYC Bureau of Tuberculosis Control from 2001 to 2010 to compare South Asian patients with other Asian and other foreign-born patients. We reviewed genotyping and cluster investigation data for South Asian patients to assess the extent of genotype clustering and the possibility of local transmission in this population. Results. The observed disparity in TB rates and burden among South Asians was not explained by social or clinical characteristics. A large amount of TB strain diversity was observed among South Asians, and they were less likely than other foreign-born patients to be infected with the same TB strain as another NYC patient. Conclusions. The majority of South Asians were likely infected with TB abroad. South Asians represent a meaningful foreign-born subpopulation for targeted detection and treatment of TB infection in NYC. At the peak of the New York City (NYC) tuberculosis (TB) epidemic in 1992, there were 3811 cases of TB reported to the NYC Department of Health and Mental Hygiene, resulting in an incidence rate of 51 cases per 100 000 persons. 1 Since 1992, the number of TB cases and rate of TB in NYC have steadily declined, falling to 711 reported cases in 2010 (8.7 cases per 100 000 persons). 1 However, beginning in 1997, the number of foreign-born TB cases exceeded the number of US-born cases, and this trend has continued. In 2010, 80% of TB cases in NYC were foreign-born. 1 Although TB incidence rates have fallen for both groups, declines have been much larger among the US-born, and the difference in incidence rates between the 2 groups remains persistently high. This ongoing disparity suggests a need to better understand TB in foreign-born individuals living in NYC, a city of 8 million people, of whom approximately 40% are foreign-born. 2 Previous work has found substantial heterogeneity in the risk of TB among foreign-born people in NYC by country of birth. 3 Declining resources for TB control necessitate the identification of meaningful groupings of foreign-born populations to prioritize and target for interventions. The NYC Bureau of Tuberculosis Control (BTBC) has undertaken several projects to better understand and identify high TB burden subpopulations in NYC. 3 These efforts have identified South Asians living in NYC as a particular group of interest. In 2010, more than one third of the world’s TB patients lived in South Asia, and 4 of the World Health Organization’s top 22 high TB burden countries are in South Asia. 4 In NYC, several South Asian countries were among the top 10 most common countries of birth for foreign-born TB patients from 2001 to 2010. Furthermore, although 7% of all foreign-born residents of NYC originated from South Asia in 2010, this group accounted for 13% of new foreign-born TB patients. 5 In this analysis, we have described the characteristics of South Asian TB patients and compared them with other foreign-born patients living in NYC to explore the disproportionate burden of TB in the South Asian population.
