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

  • Barbara H. BardenheierEmail author
  • Meda E. Pavkov
  • Carla A. Winston
  • Alex Klosovsky
  • Catherine Yen
  • Stephen Benoit
  • Stefan Gravenstein
  • Drew L. Posey
  • Christina R. Phares
Original Paper


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.


Chronic kidney disease Tuberculosis Refugees 



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.

Compliance with Ethical Standards

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.


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Barbara H. Bardenheier
    • 1
    Email author
  • Meda E. Pavkov
    • 1
  • Carla A. Winston
    • 1
  • Alex Klosovsky
    • 2
  • Catherine Yen
    • 2
  • Stephen Benoit
    • 1
  • Stefan Gravenstein
    • 3
  • Drew L. Posey
    • 1
  • Christina R. Phares
    • 1
  1. 1.Centers for Disease Control and PreventionAtlantaGeorgia
  2. 2.International Organization for MigrationWashingtonUSA
  3. 3.Brown UniversityProvidenceUSA

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