GENDER DIFFERENCES IN EARLY SUSPICION OF TUBERCULOSIS IN HOSPITALIZED, HIGH-RISK PATIENTS DURING 4 EPIDEMIC YEARS, 1987 TO 1990

Objectives: To assess the degree to which, from 1987 to 1990, physicia ns suspected tuberculosis (TB) in the first 2 hospital days in human i mmunodeficiency virus (HIV)-infected patients with pulmonary disease. Design: Retrospective cohort study. Setting: 96 hospitals in five US c ities. Patients: 2174 adult patients with acquired immunodeficiency sy ndrome discharged with a diagnosis of Pneumocystis carinii pneumonia f rom 1987 to 1990. The diagnosis generally was not known on admission. Results: Physicians suspected TB in the first 2 hospital days in 66% o f these patients in 1987, a rate that increased steadily to 74% in 199 0. However, the extent to which physicians considered TB among female patients decreased from 76% to 71% over the 4 years. Controlling for c onfounding variables by multiple logistic regression, the odds that TB would be suspected early increased 1.8-fold among men (odds ratio [OR ], 1.8; 95% confidence interval [CI95], 1.4-2.4), but not in women (OR , 0.6; CI95, 0.2-1.9). Among the five cities, the odds of early suspic ion of TB increased most in New York City (OR, 3.9; CI95, 2.0-7.9). Co nclusions: Physicians considered TB in a timely manner in an increasin g majority of male, but not female, high-risk patients during the firs t years of TB resurgence in the United States. Physicians must be awar e of the changing epidemiology of HIV and TB, as well as their practic e patterns, to prevent nosocomial transmission of this disease.