(B-193) Characterizing Latent Tuberculosis and Screening among Individuals diagnosed with Active Tuberculosis Disease in the United States

Background: Active tuberculosis (TB) disease has continued to increase in the United States since 2020, and 80% of TB cases are due to activation of latent TB infections. Tuberculosis screening and prevention therapy can prevent TB disease activation but may be differentially provided or accessed.

Objectives: To characterize individuals with TB by latent TB diagnosis and TB screening status in the real-world setting.

Methods: This retrospective, observational study identified patients diagnosed with TB (ICD-10-CM: A15) from the OMNY Health real-world data platform from 2020 - 2024. This database utilized electronic health records from United States (US) health systems. The earliest date of TB diagnosis was considered the index date. Demographic and clinical characteristics were described on the index date or during the pre-index period. The utilization of TB screening procedures (CPT: 86480, 86481, 86580, 182879, 182893; ICD-10-CM: Z11.1; “TB-screened”) or diagnosis of latent TB (ICD-10-CM: Z22.7, Z86.15) were evaluated during the pre-index period. Descriptive statistics were reported for all variables of interest.

Results: A total of 6,538 individuals were diagnosed with TB, 238 (4%) of whom had a latent TB diagnosis code before the index date and 1287 (20%) of whom had evidence of TB screening before the index date. The distribution of gender (53% female) and age (mean: 52 years) was similar across the overall and latent TB populations. The TB-screened cohort had a higher proportion of females and lower mean age compared to the overall population. 53%, 69%, and 42% reported a non-white race among the overall, latent TB, and TB-screened populations, respectively, and 17% of individuals with latent TB were Hispanic among patients with ethnicity data. Social determinants of health (SDoH) domains, comprising lack of educational access, income insecurity, and transportation insecurity, were reported in the pre-index period for 4% of the population. Among those individuals who responded to the SDoH domains, greater burden was observed among individuals who were screened for TB (30%) compared to individuals who were diagnosed with latent TB (5%).

Conclusions: TB screening was more likely to be observed in women and younger individuals and less likely to be observed in non-white and Hispanic individuals. The higher proportion of latent TB observed among the Hispanic population may align with higher risk profiles among individuals who are not born in the US or who travel outside of the US to high-risk countries. The higher burden of SDoH responses among individuals who screened for TB (compared to those diagnosed with latent TB) may demonstrate barriers to accessing prevention strategies. Operational research is needed to understand the patient pathway for TB prevention in the US.