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


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.

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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.

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Correspondence to Barbara H. Bardenheier.

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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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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).

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  • Chronic kidney disease
  • Tuberculosis
  • Refugees