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Risk Factors for a Positive Tuberculin Skin Test among Employees of an Urban, Midwestern Teaching Hospital

Thomas C. Bailey, MD; Victoria J. Fraser, MD; Edward L. Spitznagel, PhD; and W. Claiborne Dunagan, MD
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From the Washington University School of Medicine, St. Louis, Missouri. Requests for Reprints: Thomas C. Bailey, MD, Box 8217, Washington University School of Medicine, 660 South Euclid, St. Louis, MO 63110. Acknowledgments: The authors thank J. Russell Little, MD, and Gerald Medoff, MD, for their constructive comments. Grant Support: In part by Barnes Hospital, St. Louis, Missouri.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;122(8):580-585. doi:10.7326/0003-4819-122-8-199504150-00004
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Objective: To determine the prevalence and incidence of and the relative risks for positive tuberculin skin tests among employees of a large, urban teaching hospital.

Design: Retrospective cohort study.

Setting: Barnes Hospital, St. Louis, Missouri.

Participants: Hospital personnel employed at any time between January 1989 and July 1991.

Results: 684 of 6070 employees screened (11.3% [95% CI, 10.4% to 12.1%]) had positive tuberculin skin tests. Factors associated with a positive result were age (odds ratio, 2.02 per decade [CI, 1.87 to 2.18]; P < 0.0001); black race (odds ratio, 1.58 [CI, 1.26 to 2.00]; P < 0.0001); Asian race (odds ratio, 16.7 [CI, 9.33 to 29.9]; P <0.0001); Hispanic ethnicity (odds ratio, 9.45 [CI, 3.58 to 25.0]; P <0.0001); and percentage of low-income persons within the employee's residential postal zone (odds ratio, 1.14 per 10% [CI, 1.05 to 1.23]; P = 0.001). Twenty-nine of 3106 employees who had at least two tests had skin-test conversions (0.93% [CI, 0.60% to 1.3%]); 15 of these conversions (52%) occurred among employees who had no direct contact with patients. Only the percentage of low-income persons within the employee's residential postal zone (odds ratio 1.39 [CI, 1.09 to 1.78]; P = 0.0075) was independently associated with conversion.

Conclusions: The most important associations with a positive tuberculin skin test were older age, minority group status, and the proportion of low-income persons within the employee's residential postal zone. Skin-test conversion was independently associated only with the percentage of low-income persons in the employee's postal zone. Stratifying employees according to degree of contact with patients or according to departmental group was not useful in determining risk for a positive tuberculin skin test or for skin-test conversion. For certain groups of employees, an exposure to tuberculosis in the community probably poses a greater risk than exposure in the hospital setting.


Grahic Jump Location
Figure 1.
Relation of positive tuberculin skin tests to age and race.

White bars represent whites; striped bars represent blacks. Vertical bars indicate the 95% CIs.

Grahic Jump Location




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