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Author Notes:

Correspondence: Argita Salindri, MPH, Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Urban Life Building, SE, Atlanta, GA 30303, asalindri1@student.gsu.edu, Phone: +1 404 413 1447

We would like to thank Dr. Rose-Marie Sales (Georgia Department of Public Health) for her assistance in acquiring the dataset and feedback for this project.


Research Funding:

This work was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health [R03AI133172 to M.J.M, K24AI114444 to N.R.G, and K23AI134182 to S.C.A].


  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • Tuberculosis
  • Tuberculin skin test
  • Mortality risk
  • Diabetes
  • HIV
  • Pulmonary tuberculosis
  • Anergy
  • Cohort
  • Risk

Negative tuberculin skin test result predicts all-cause mortality among tuberculosis patients with HIV and diabetes comorbidity


Journal Title:

Annals of Epidemiology


Volume 33


, Pages 72-78

Type of Work:

Article | Post-print: After Peer Review


Purpose: The purpose of this study was to determine if a negative tuberculin skin test (TST) result is associated with increased risk of mortality during tuberculosis (TB) treatment. Methods: We conducted a retrospective cohort study among patients aged ≥15 years with culture-positive TB reported to the Georgia State Electronic Notifiable Disease Surveillance System from 2009 to 2014. TST positivity was defined by the US Centers for Disease Control guidelines. All-cause mortality during TB treatment as well as HIV, diabetes, and end-stage renal disease status were collected from surveillance data. Log-binomial regression was used to estimate adjusted risk ratios and 95% confidence intervals. Results: Among 1186 culture-confirmed TB patients, 780 (65.8%) with a valid TST and TB treatment outcomes were eligible. Nearly one-third (242/780) had a negative TST result, and 5.6% died during treatment. The highest risk of death was observed among patients with a negative TST and HIV (12.5%) and a negative TST and diabetes (15.4%). Adjusting for confounders, the risk of death among patients with a negative TST was significantly greater compared with those with a positive TST (adjusted risk ratio 2.33 95% confidence interval 1.23–4.43). Conclusions: A negative TST was associated with more than twice the risk of mortality during TB treatment after adjusting for immunosuppressive conditions.

Copyright information:

© 2019 Elsevier Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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