A new study raises the question, do barriers to health care for undocumented immigrants increase the public health risk of tuberculosis? The study, published in the November 15, 2008 issue of Clinical Infectious Diseases and now available online, suggests that undocumented immigrants with tuberculosis have symptoms longer before seeking care than documented immigrants or U.S.-born patients, resulting in more severe symptoms and more opportunities for transmission. These findings raise questions about the value to both patients and the public of improving access to health care for undocumented immigrants.
Rates of tuberculosis are declining overall in the United States, but the proportion occurring among foreign-born persons is increasing and the case rate is almost 10 times higher than that among persons born in the United States. Furthermore, funding for tuberculosis elimination is declining, leading to concerns about a resurgence of the disease.
In a review of medical records for patients diagnosed with pulmonary tuberculosis at a New York City hospital between April 1999 and March 2005, the authors of this study investigated whether there were any differences in clinical presentation among U.S.-born, foreign-born and documented, or foreign-born and undocumented individuals. Of 194 patients with newly diagnosed pulmonary tuberculosis, 31 percent were U.S.-born, 32 percent were foreign-born and documented, and 37 percent were foreign-born and undocumented. Undocumented patients exhibited an increased frequency of cough, bloody expectoration, and a much longer duration of symptoms prior to hospitalization compared to U.S.-born patients.
The median symptom duration in undocumented patients was eight weeks, compared to four weeks in U.S.-born and documented foreign-born patients. The significantly higher frequency of cough combined with prolonged symptom duration in undocumented foreign-born individuals could potentially lead to an increased exposure of close contacts. Whether or not they transmit tuberculosis more often than documented foreign-born or U.S.-born individuals, and what role barriers to health care access plays, requires further investigation.
"This is a small study and the findings are preliminary," said study author Dr. Jacqueline Achkar, MD, of the Albert Einstein College of Medicine. "If larger studies confirm our data, it raises a legitimate public health issue. We will need to identify and address barriers to health care access for undocumented immigrants. Such an initiative would benefit both the population studied as well as the health of the public."