Private Sector Opportunities to Mitigate Disparities in Tuberculosis Risk among Foreign-born Individuals in the US: Data from the 2011-2012 National Health and Nutrition Examination Survey.

Background: Over two-thirds of active tuberculosis (TB) cases in the US occur among foreign-born persons, yet there are disparities in how well domestic TB elimination strategies have addressed TB risk in foreign-born versus US-born individuals. With 90% of incident active TB cases among foreign-born persons stemming from reactivation of latent TB infections (LTBI), there is a need to increase targeted LTBI testing and treatment in this population. If LTBI-positive foreign-born persons have access to and use health insurance and private sector healthcare it may be feasible to conduct LTBI-related preventive care services in that setting. Aims: (1) Estimate LTBI prevalence among foreign-born individuals by health insurance status and usual source of healthcare (USHC); and (2) examine insurance coverage and USHC among foreign-born persons with LTBI. Methods: We analyzed 2011-12 National Health and Nutrition Examination Survey (NHANES) data for civilian, noninstitutionalized, foreign-born persons ages 6 years or older with interferon gamma release assay (IGRA) results and self-reported insurance and USHC data (N=1,793). Results: Overall, 15.9% of our sample were LTBI-positive per IGRA results. Of these, almost two-thirds had some form of insurance and over three-quarters had a USHC. While LTBI prevalence was highest among Medicare beneficiaries, many had private insurance. Conclusion: Both health insurance and USHC were common within LTBI-positive foreign-born individuals residing in the US. Our results suggest that targeted LTBI-related care within the US private healthcare sector could reach the majority of foreign-born persons with LTBI and thus reduce disparities in TB risk.