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Date Available

5-6-2026

Year of Publication

2026

Document Type

Graduate Capstone Project

Degree Name

Master of Public Health (M.P.H.)

College

Public Health

Department/School/Program

Public Health

Faculty

Kathleen Winter

Committee Member

Fulk Florence

Faculty

Anne Ray

Abstract

Objective: Tuberculosis (TB) remains an important public health concern in the United States, especially among people experiencing social and clinical vulnerabilities. Extrapulmonary TB, which occurs outside of the lungs, can be harder to detect and diagnose than pulmonary TB. This study aimed to describe the demographic and clinical characteristics of people with active TB in Kentucky and to identify factors associated with extrapulmonary TB.

Methods: Secondary surveillance data were obtained from the Kentucky Department for Public Health (KDPH) using the National Tuberculosis Surveillance System (NTSS). The study sample included 301 confirmed active TB cases reported in Kentucky. Descriptive statistics were used to summarize the data and case characteristics; chi-square tests and Fisher’s exact tests were used to compare pulmonary and extrapulmonary TB cases across demographic, behavioral, and clinical variables. A t-test was used to compare the mean treatment length. In addition, calculated prevalence ratios (PRs), 95% confidence intervals (CIs), and p-values to find factors associated with extrapulmonary TB status.

Results: Out of the 301 active TB cases included in the analysis, 66 cases (21.9%) had extrapulmonary TB and 235 cases (78.1%) had pulmonary TB. Statistically significant differences were found in smoking history (p = .0077), country of birth (p = .0066), verification criteria (p = .0020), sputum smear status (p < .0001), and diabetes status (p = .0256). People who were born outside the United States were more than twice as likely to have extrapulmonary TB compared to those born in the United States (PR = 2.17, 95% CI: 1.19–3.94). Positive sputum smear results and having diabetes were associated with a lower prevalence of extrapulmonary TB. No statistically significant differences were seen based on sex, age, race, ethnicity, homelessness, alcohol use, treatment length, or treatment status.

Conclusion: Analysis of tuberculosis cases in Kentucky revealed that extrapulmonary TB was significantly associated with specific demographics and clinical characteristics. Notably, persons not born in the U.S. were identified as a significant risk factor for extrapulmonary TB compared to pulmonary TB. These findings show the importance of continued TB surveillance and improved awareness when diagnosing extrapulmonary TB, especially for groups at higher risk for extrapulmonary disease. Strengthening early detection and focusing on public health strategies may help to improve TB control efforts in Kentucky.

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