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Author Notes:

Corresponding author (e-mail: mhaddad@cdc.gov).

M.B.H. conceptualized the analysis, and all of the authors contributed to its design. M.B.H. executed the analysis and prepared the first draft of the article within the National Center for Health Statistics Research Data Center.

M.B.H. and K.M.R. created the non–National Health and Nutrition Examination Survey county-level dataset.

All of the authors provided critical revisions and approved the final version of the manuscript.

The authors thank Wanjun (June) Cui, Frances McCarty, and other National Center for Health Statistics staff for their gracious assistance in facilitating access to restricted NHANES variables in the National Center for Health Statistics Research Data Center in Atlanta.

The authors also thank NHANES participants and staff for making this survey possible.

Author disclosures are available with the text of this letter at www.atsjournals.org.


Research Funding:

This is publicly funded research by employees of the Centers of Disease Control and Prevention (M.B.H., K.M.R., A.N.H., T.R.N., C.A.W.).

Also supported by an existing U.S. Agency for International Development Intergovernmental Personnel Act agreement with Emory University (K.G.C.) and a K24 grant (1K24AI114444) funded by National Institute of Allergy and Infectious Diseases, National Institutes of Health, U.S. Department of Health and Human Services (N.R.G.)


  • Science & Technology
  • Life Sciences & Biomedicine
  • Respiratory System

Influence of County Sampling on Past Estimates of Latent Tuberculosis Infection Prevalence


Journal Title:

Annals of the American Thoracic Society


Volume 16, Number 8


, Pages 1069-1071

Type of Work:

Article | Final Publisher PDF


The National Health and Nutrition Examination Survey (NHANES) has tested for Mycobacterium tuberculosis infection three times: in 1971–1972, 1999–2000, and 2011–2012. Based on tuberculin skin test results, the estimated national prevalence of latent tuberculosis infection (LTBI) among adults was 11–18% in 1971–1972 but has remained less than or equal to 6% in subsequent NHANES cycles (1–4). A single 2-year NHANES cycle is designed to produce accurate and stable estimates for conditions with at least 10% prevalence in the noninstitutionalized civilian U.S. population (5–7), suggesting that NHANES might no longer be as nationally representative for LTBI as it is for more common health conditions. Approximately 30 counties were selected for each 2-year cycle (5). We wished to examine whether persons in selected counties might have been systematically more or less likely to have a positive tuberculin skin test result than their counterparts in the approximately 3,100 counties that were not selected for NHANES participation.

Copyright information:

© 2019 by the American Thoracic Society

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