Hispanic or Latino ethnicity, confirmed diabetes, or living in an area with low health equity were each found to be risk factors for a dual diagnosis of Covid-19 and tuberculosis in a cross-sectional analysis conducted in California.
The death rate among people with Covid-19 and tuberculosis (TB) was also more than twice that reported among people with TB alone before the Covid-19 pandemic and more than 20 times higher than reported among people with Covid-19 without TB during the pandemic.
When adjusted for age, the death rate among people with comorbid TB and Covid-19 remained higher than that of people with either disease alone, wrote researcher Scott Nabity, MD, MPH, of the California Department of Public Health, and colleagues.
“Tuberculosis disproportionately occurs in medically and socially vulnerable communities, and these results suggest potential benefit from the integration of TB and Covid-19 prevention efforts, such as combining Covid-19 vaccination outreach with targeted screening for TB,” the researchers wrote.
They noted that the while the U.S. has a low TB burden, about a quarter of cases occur in California, which has a diverse population of around 40 million.
“Although TB and Covid-19 share some medical risk factors, little is known about the epidemiologic intersection of these primarily respiratory diseases, especially in settings with low TB incidence,” they wrote.
Nabity and colleagues conducted a cross-sectional analysis of public health surveillance records in California in an effort to better understand the sociodemographic, clinical, and epidemiologic characteristics of comorbid TB and Covid-19.
The analysis included TB cases diagnosed and reported before the Covid-19 pandemic (January 2017 through December 2019) and those diagnosed after the start of the pandemic. Covid-19 cases were identified through early February 2021.
A total of 3.4 million California residents were identified with Covid-19 alone, 6,280 were diagnosed with TB before the start of the pandemic, and 91 people were identified with a confirmed or probable Covid-19 diagnosis within 120 days of a TB diagnosis.
The median age of those with a dual TB and Covid-19 diagnosis was 58 years (range 3-95 years), and 52 (57%) were male. Eighty-one (89%) were born outside the U.S. and 55 (60.4%) were Hispanic or Latino. Just over 30% were Asian or Pacific Islander and 4.4% were Black.
Among those receiving a TB diagnosis from early September 2019 through December 2020, Covid-19 was identified in 225 of 2,210 (10.2%), which was similar to the 8.6% infection rate reported for the general population of Californians during the period.
Compared to people diagnosed with TB before the pandemic, those with a dual diagnosis of TB and Covid-19 were more likely to be Hispanic or Latino (36.4% versus 60.4%), reside in low health equity census areas (32.9% versus 44.9%), live in the U.S. longer before receiving a TB diagnosis (median 19.7 years versus 23.1 years), and have diabetes (27.6% versus 46.2%).
Fifteen deaths occurred among the 91 people with TB and Covid-19. Among those with successive diagnoses of TB and Covid within 30 days, the frequency of death was more than twice that of people with TB before the pandemic (23.5% versus 11.4%) and almost 20-times the 1.2% mortality rate reported among people with Covid-19 alone.
“This cross-sectional analysis is, to our knowledge, one of the first population-based analyses of TB and Covid-19 surveillance data in a low-incidence setting for TB,” the researchers wrote. “We found that California residents with TB-Covid-19 had characteristics that were generally similar to those of persons with TB before the Covid-19 pandemic… Nevertheless, we identified characteristics that were more common among persons with TB/Covid-19, including Hispanic or Latino ethnicity, the presence of diabetes, and residence in low health equity census tracts, which reflected Covid-19 disparities in California. “
Study limitations cited by the researchers included the inability to measure certain clinical characteristics associated with disease severity, such as hospitalization, and the lack of information on circumstances associated with death. They further noted that the small number of people with co-morbid TB and Covid-19 “produced wide ranges in CIs for rate comparisons.”
“Nevertheless, we likely underestimated mortality among persons with TB/Covid-19 because follow-up surveillance reporting for TB, which captures death at any point during TB treatment, is not yet complete for 2020,” they wrote.
The death rate among people with Covid-19 and tuberculosis (TB) was more than twice that reported among people with TB alone before the Covid-19 pandemic and more than 20 times higher than reported among people with Covid-19 without TB during the pandemic.
Hispanic or Latino ethnicity, having diabetes, and living in an area with low health equity were all risk factors for comorbid Covid-19 and tuberculosis in a cross-sectional analysis conducted in California.
Salynn Boyles, Contributing Writer, BreakingMED™
The researchers reported no funding source nor conflicts of interest related to this study.
Cat ID: 125
Topic ID: 79,125,585,730,933,125,926,192,927,151,928,925,934