摘要：Objectives. We sought to identify correlates of reported lifetime diagnoses of TB among injection drug users in the border city of Tijuana, Mexico. Methods. Injection drug users in Tijuana were recruited into a prospective cohort study during 2006 and 2007. We used weighted multivariate logistic regression to identify correlates of TB diagnoses. Results. Of the 1056 participants, 103 (9.8%) reported a history of TB, among whom 93% received anti-TB medication and 80% were diagnosed in the United States. Treatment was prematurely halted among 8% of patients; deportation from the United States was the cause of half of these treatment interruptions. History of travel to (odds ratio [OR] = 6.44; 95% confidence interval [CI] = 1.53, 27.20) or deportation from (OR = 1.83; 95% CI = 1.07, 3.12) the United States and incarceration (OR = 2.20; 95% CI = 1.06, 4.58) were independently associated with a reported lifetime diagnosis of TB. Conclusions. Mobility and migration are important factors in identifying and treating TB patients diagnosed in the US–Mexico border region. Strengthening capacity on both sides of the border to identify, monitor, and treat TB is a priority. The epidemiology of tuberculosis (TB) is of special importance in border regions and areas with high concentrations of immigrants. 1 Foreign-born individuals account for more than half of the TB cases in the United States, 2 with the highest number occurring among individuals born in Mexico (24% of all cases among foreign-born individuals). 3 In California, the percentages of cases among foreign-born individuals (77%) and Mexican-born individuals (31% of cases among the foreign-born population) are even higher. 4 The potential for TB to spread across international borders recently entered the national consciousness when a traveler who had acquired multidrug-resistant TB provoked the first federal quarantine since 1963. 5 At present, the US Centers for Disease Control and Prevention recommend latent TB infection (LTBI) screening for immigrants from countries with high TB prevalence rates who have spent 5 or less years in the United States. 6 The Mexican state of Baja California, adjacent to California, has the highest incidence of TB in Mexico: 57.3 cases per 100 000 individuals, or nearly triple the national average. 7 California has the highest total number of TB cases in the United States and the fourth highest incidence (7.6 per 100 000), following the District of Columbia, Alaska, and Hawaii. 8 San Diego, California, and Tijuana, the largest city in Baja California, share the world's busiest land border; 42 000 people cross daily from Tijuana to work in the United States, 9 and 46 million northbound trips are made each year. 10 With such an active and dynamic border area, it is not surprising that TB patients from both Tijuana and San Diego report contact with residents from the opposite side of the border. 11 Research has shown that drug users, and injection drug users in particular, frequently travel back and forth across the US–Mexico border 12 and that these individuals are at high risk of acquiring TB. 6 , 13 , 14 Levels of drug use in Tijuana, which is located on a major drug trafficking route, are 3 times higher than Mexico's national average. 15 A recent study conducted by our group showed that 70% of injection drug users in Tijuana had LTBI, and latent infection was significantly more prevalent among those who had been born in Mexico or who had lived in Tijuana their entire lives. 16 For our study, we investigated correlates of self-reported lifetime diagnoses of TB among injection drug users in Tijuana.
