High-risk women underdiagnosed for TB

In the first known study measuring how aggressively physicians consider diagnosis of tuberculosis in high-risk groups, researchers found that the rate of diagnosis decreased in women while increasing in men during a three-year period.

The study, published in Infection Control and Hospital Epidemiology, evaluated 2,174 HIV-positive adults discharged from five city hospitals between 1987 and 1990 with a diagnosis of Pneumosistis carinii pneumonia.1 The researchers then attempted to discern to what extent physicians seriously considered TB in those patients, whose immune status would put them at high risk for the disease.

During the four-year period, the overall rate of suspected TB increased from 66% to 74%. However, the rate of suspicion decreased for women during the same period from 76% to 71%.

The findings conform to other studies of diagnosis and treatment of HIV-positive women, which have reported gender differences in medical services, including fewer diagnostic tests and drug prescriptions for women.

"These findings are important with respect to public health because TB incidence has increased in both genders, and women account for 30% of the excess cases of TB from 1985 through 1992," the authors note. "Furthermore, HIV infection is increasing rapidly among women in the United States."

The authors did not speculate as to reasons for the gender differences in diagnosis but cautioned that their study had several limitations. Nonetheless, they urged physicians to be more aware of demographic trends for tuberculosis and HIV.


1. Cegielski J, Goetz M, Jacobsen J, et al. Gender differences in early suspicion of tuberculosis in hospitalized, high-risk patients during four epidemic years, 1987-1990. Infect Control Hosp Epidemiol 1997;18:237-243.