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APPENDIX A ADDITIONAL US AND TERRITORIES REPORTED TO THE NATIONAL TUBERCULOSIS SURVEILLANCE SYSTEM, 2011–2018 ( M49 NAMES AS OF JANUARY 2020 [A1])

Africa Eastern Europa Island French Southern Territories South United Republic of

Middle Africa Congo Democratic Equatorial Zaire

Northern Africa Sudan

Southern Africa Swaziland

Western Africa Cabo Verde Côte d’Ivoire Gambia Guinea Guinea-Bissau Saint Helena

Americas Bahamas Saint Vincent and the Grenadines

Central America

Northern America

South America (Plurinational State of) (Bolivarian Republic of)

Asia Central

Eastern Asia China, Special Administrative Region (SAR) China, Macao Special Administrative Region (SAR) Democratic People’s Republic of Korea Republic of Korea Taiwan (Republic of China)*

South-eastern Asia Burma Lao People’s Democratic Republic Viet Nam

Southern Asia (Islamic Republic of)

Western Asia Syrian Arab Republic

Europe Eastern Czechia Republic of Russian Federation

Northern Europe Ireland of Great Britain and Northern Ireland

Southern Europe Republic of Kosovo* Yugoslavia

Western Europe

Oceania and Australia New Zealand

Melanesia

Micronesia (Federated States of)

Polynesia Pitcairn

*Lacks United Nations M49 designation.

Reference

A1. United Nations Statistics Division. Standard or area codes for statistical use (M49) [Internet]. New York: United Nations; [cited 2020 March 2]. https://unstats.un.org/unsd/methodology/m49/ APPENDIX B TECHNICAL APPENDIX

Birth country categorization

We initially categorized each National Tuberculosis Surveillance System (NTSS)-reported country or territory into 15 subregions and 7 intermediary regions, which are further subdivisions of the Sub-Saharan Africa and and the Caribbean subregions under the United

Nations (UN) M49 standard (B1). Because of low reported case numbers, we analyzed the subregions of Australia and New Zealand, , Micronesia, and together under the continental region , which encompasses these subregions under the UN M49 standard. As a result, we examined 19 total regions in our analysis. We categorized countries that have changed names but not geographical boundaries (e.g., Burma/Myanmar and

Zaire/Democratic Republic of the Congo) under the region in which the most current country name is categorized and countries that have changed geographical boundaries (e.g., Yugoslavia and Czechoslovakia) under the region in which successor countries were categorized. Finally, where the UN does not recognize a country that NTSS reports as a birth country, we assigned that country to a region according to geographic proximity to other countries within that region.

Exclusion of race/ethnicity variable

We assessed for multicollinearity between race/ethnicity and birth region using Cramer’s V instead of the chi-square test because of the large sample size in this study. Cramer’s V was 0.73, suggesting a strong association race/ethnicity and birth region; therefore, we excluded race/ethnicity as a variable in this study because of concerns for multicollinearity and to maintain model parsimony.

Cox regression assumptions

We determined if the data met the proportional hazards assumption for Cox regression by

generating Schoenfeld residual plots for each demographic covariate, where we evaluated for

independence between residuals and time. A nonrandom pattern against time is evidence of

violation of this assumption; because we observed no such pattern, the data met the proportional

hazards assumption. We also assessed for nonlinearity of the age variable, which we treated as

continuous for the Cox regression analysis, by visualizing Martingale residuals and checking for

a symmetric distribution around 0; because the age variable demonstrated linearity, we kept it as

continuous for the Cox regression analysis.

Double-truncation

Because this is a retrospective study examining TB cases reported to NTSS from a US jurisdiction, we cannot observe non–US-born persons who developed TB disease before entering the (i.e., left truncation), nor can we observe non–US-born persons who will develop TB disease in the future (i.e., right truncation). This phenomenon is known as double- truncation and reflects a sampling bias in which we lack information regarding the entire cohort of non–US-born persons who moved to the United States and at some point develop TB disease.

To remedy this sampling bias, we applied a weighted estimation approach that produces weighted estimators of the hazard ratio (B2). In this approach, the weights are inversely proportional to the probability that a subject is included in the sample (i.e., not truncated), and this probability is conditional on observed survival time; as a result, observations with oversampled survival times are downweighted, and observations with undersampled survival times are upweighted (B2). We used this approach to generate our Cox regression model (R code sourced from Rennert and Xie, 2018). The percentage differences in adjusted hazard ratios between adjusting for double truncation and not adjusting for double truncation are displayed in

Table B1.

Our adjustment for double-truncation was subject to a key limitation in that we could not properly test for quasi-independence between truncation times (i.e., time from US entry to study start date and time from US entry to study end date) and event time, which is a necessary precondition for our method of adjustment; because of the large number of observations examined, we could not correctly assess the p value for the conditional Kendall tau used to test quasi-independence. Because no a priori reasons exist to assume dependence between these times, we assumed quasi-independence for the purpose of this analysis. The standard errors for the hazard ratios derived when adjusting for double-truncation are smaller than those derived when not making this adjustment, indicating improved accuracy when adjusting for double truncation (Table B1).

Table B1. Comparison of adjusted hazard ratio (aHR) and standard error estimates of tuberculosis disease onset for non–US-born persons with tuberculosis disease not attributed to recent transmission when adjusting and not adjusting for double truncation — United States, 2011–2018

aHR Standard error Not Not Adjusting adjusting Adjusting adjusting for double- for double- % for double- for double- % Characteristic truncation truncation difference truncation truncation difference Age (yrs) 0.95 0.96 1.1 0.0004 0.001 150.0 Sex Male Ref Ref Ref Ref Ref Ref Female 1.11 1.07 –3.6 0.004 0.01 150.0 Birth year 1900–1919 0.01 1.69 16,800.0 0.04 0.14 250.0 1920–1939 1.30 1.47 13.1 0.02 0.04 100.0 1940–1959 1.10 1.05 –4.5 0.01 0.03 200.0 1960–1979 Ref Ref Ref Ref Ref Ref 1980–1999 1.11 1.34 20.7 0.01 0.02 100.0 2000–2018 0.93 1.32 41.9 0.03 0.08 166.7 Region Africa Eastern Africa 3.91 4.06 3.8 0.03 0.12 300.0 Middle Africa 7.02 7.50 6.8 0.04 0.14 250.0 Northern Africa 3.43 3.78 10.2 0.04 0.15 275.0 4.19 4.15 –1.0 0.06 0.18 200.0 Western Africa 4.84 4.80 –0.8 0.03 0.13 333.3 Caribbean 2.82 2.86 1.4 0.03 0.12 300.0 2.03 2.18 7.4 0.03 0.12 300.0 * 1.13 1.05 –7.1 0.07 0.25 257.1 2.85 2.91 2.1 0.03 0.12 300.0 Asia 4.71 4.71 0.0 0.06 0.19 216.7 Eastern Asia 2.88 3.00 4.2 0.03 0.12 300.0 South-eastern Asia 3.06 2.96 –3.3 0.03 0.12 300.0 Southern Asia 4.29 4.24 –1.2 0.03 0.12 300.0 3.34 3.61 8.1 0.04 0.14 250.0 Europe 2.77 2.90 4.7 0.04 0.13 225.0 1.12 1.05 –6.3 0.05 0.19 280.0 1.25 1.93 54.4 0.04 0.14 250.0 Ref Ref Ref Ref Ref Ref Oceania 2.78 2.87 3.2 0.04 0.15 275.0 Abbreviations: NA: not available; Ref: reference value. * Excludes the United States of America.

References

B1. United Nations Statistics Division. Standard country or area codes for statistical use (M49) [Internet]. New York: United Nations; [cited 2020 March 2]. https://unstats.un.org/unsd/methodology/m49/ B2. Rennert L, Xie SX. Cox regression model with doubly truncated data. Biometrics. 2018;74:725–33. doi:10.1111/biom.12809

APPENDIX C SUPPLEMENTARY TABLES AND FIGURES (UNITED NATIONS M49 NAMES AS OF JANUARY 2020 [C1])

Table C1. Adjusted hazard ratio (aHR) estimates of tuberculosis disease diagnosis for non–US- born persons with tuberculosis disease not attributed to recent transmission (n = 28,450) — United States, 2011–2018

Characteristic No. (%) aHR 95% CI p value Age at diagnosis (yrs) 0.95 (0.95–0.95) <0.01 0–4 9 (0.03) NA NA NA 5–14 101 (0.4) NA NA NA 15–24 2,682 (9.4) NA NA NA 25–44 10,029 (35.3) NA NA NA 45–64 8,144 (28.6) NA NA NA ≥65 7,485 (26.3) NA NA NA Sex Male 16,864 (59.3) Ref Ref Ref Female 11,586 (40.7) 1.11 (1.10–1.12) <0.01 Birth year 1900–1919 66 (0.2) 0.01 (0.01–0.01) <0.01 1920–1939 3,717 (13.1) 1.30 (1.27–1.34) <0.01 1940–1959 7,519 (26.4) 1.10 (1.08–1.12) <0.01 1960–1979 8,707 (30.6) Ref Ref Ref 1980–1999 8,224 (28.9) 1.11 (1.09–1.13) <0.01 2000–2018 217 (0.8) 0.93 (0.88–0.98) <0.01 Region Africa 2,910 (10.2) Eastern Africa 1,627 (5.7) 3.91 (3.67–4.17) <0.01 Middle Africa 286 (1.0) 7.02 (6.53–7.56) <0.01 Northern Africa 126 (0.4) 3.43 (3.15–3.75) <0.01 Southern Africa 56 (0.2) 4.19 (3.74–4.70) <0.01 Western Africa 815 (2.9) 4.84 (4.54–5.17) <0.01 Americas 9,719 (34.2) Caribbean 1,241 (4.4) 2.82 (2.65–3.01) <0.01 Central America 7,114 (25.0) 2.03 (1.91–2.15) <0.01 Northern America* 20 (0.1) 1.13 (0.99–1.29) 0.07 South America 1,344 (4.7) 2.85 (2.68–3.03) <0.01 Asia 14,999 (52.7) Central Asia 45 (0.2) 4.71 (4.17–5.32) <0.01 Eastern Asia 2,924 (10.3) 2.88 (2.71–3.07) <0.01 South-eastern Asia 7,812 (27.5) 3.06 (2.89–3.26) <0.01 Southern Asia 4,026 (14.2) 4.29 (4.04–4.57) <0.01 Western Asia 192 (0.7) 3.34 (3.09–3.62) <0.01 Europe 669 (2.4) Eastern Europe 328 (1.2) 2.77 (2.58–2.98) <0.01 Northern Europe 47 (0.2) 1.12 (1.01–1.23) 0.03 Southern Europe 226 (0.8) 1.25 (1.17–1.35) <0.01 Western Europe 68 (0.2) Ref Ref Ref Oceania 153 (0.5) 2.78 (2.56–3.02) <0.01 Australia and New Zealand 1 (0.004) NA NA NA Melanesia 10 (0.04) NA NA NA Micronesia 113 (0.4) NA NA NA Polynesia 29 (0.1) NA NA NA Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * Excludes United States of America.

Table C2. Comparison of adjusted hazard ratio (aHR) estimates of tuberculosis disease not attributed to recent transmission for non–US-born persons according to changes in exclusion criteria and region classification — United States, 2011–2018

aHR Original Exclude Exclude exclusion ≤6 months in persons aged Characteristic criteria United States <5 years Age (yrs) 0.95 0.95 0.95 Sex Male Ref Ref Ref Female 1.11 1.11 1.11 Birth year 1900–1919 0.01 0.01 0.01 1920–1939 1.30 1.31 1.30 1940–1959 1.10 1.09 1.10 1960–1979 Ref Ref Ref 1980–1999 1.11 1.12 1.10 2000–2018 0.93 0.88 0.91 Region Africa Eastern Africa 3.91 4.01 3.91 Middle Africa 7.02 7.36 7.04 Northern Africa 3.43 3.31 3.35 Southern Africa 4.19 4.15 4.22 Western Africa 4.84 4.91 4.85 Americas Caribbean 2.82 2.84 2.82 Central America 2.03 2.05 2.02 Northern America* 1.13 1.17 1.13 South America 2.85 2.88 2.84 Asia Central Asia 4.71 5.09 4.72 Eastern Asia 2.88 2.96 2.88 South-eastern Asia 3.06 3.15 3.07 Southern Asia 4.29 4.35 4.29 Western Asia 3.34 3.35 3.37 Europe Eastern Europe 2.77 2.78 2.77 Northern Europe 1.12 1.13 1.12 Southern Europe 1.25 1.28 1.25 Western Europe Ref Ref Ref Oceania 2.78 2.57 2.77 Abbreviation: NA: not available; Ref: reference value. * Excludes the United States of America.

Table C3. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US-born persons with tuberculosis disease not attributed to recent transmission from Eastern Africa — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.97 (0.97–0.97) <0.01 Sex Male Ref Ref Ref Female 1.09 (1.05–1.14) <0.01 Birth year 1900–1919* NA NA NA 1920–1939 1.57 (1.27–1.94) <0.01 1940–1959 1.22 (1.10–1.34) <0.01 1960–1979 Ref Ref Ref 1980–1999 1.44 (1.33–1.56) <0.01 2000–2018 1.32 (1.10–1.60) <0.01 Country of birth Burundi* Ref Ref Ref Djibouti 1.70 (1.06–2.74) 0.03 Eritrea 0.56 (0.44–0.72) <0.01 Ethiopia 0.68 (0.54–0.86) <0.01 Kenya 0.55 (0.43–0.70) <0.01 Madagascar 0.83 (0.56–1.22) 0.34 Malawi 0.73 (0.51–1.05) 0.09 Mauritius 0.10 (0.06–0.15) <0.01 Mozambique 1.02 (0.71–1.48) 0.91 Rwanda 0.76 (0.54–1.06) 0.11 Somalia 0.55 (0.43–0.70) <0.01 South Sudan 39.81 (17.01–93.16) <0.01 Uganda 0.52 (0.40–0.69) <0.01 United Republic of Tanzania 0.77 (0.57–1.05) 0.09 Zambia 0.56 (0.42–0.74) <0.01 Zimbabwe 0.37 (0.28–0.49) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations.

Table C4. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US-born persons with tuberculosis disease not attributed to recent transmission from Middle Africa — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.99 (0.99–0.99) <0.01 Sex Male Ref Ref Ref Female 1.28 (1.22–1.35) <0.01 Birth year 1900–1919* NA NA NA 1920–1939 5.48 (4.09–7.36) <0.01 1940–1959 0.24 (0.21–0.28) <0.01 1960–1979 Ref Ref Ref 1980–1999 1.46 (1.32–1.61) <0.01 2000–2018 1.39 (1.03–1.88) 0.03 Country of birth Angola Ref Ref Ref Cameroon 0.61 (0.56–0.67) <0.01 Central African Republic 1.53 (1.31–1.79) <0.01 Chad 1.00 (0.82–1.22) 1.00 Congo 0.75 (0.68–0.82) <0.01 Democratic Republic of the Congo† 0.98 (0.86–1.12) 0.78 0.93 (0.75–1.16) 0.54 Gabon 0.73 (0.59–0.91) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations. † Zaire was included under the Democratic Republic of the Congo.

Table C5. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US-born persons with tuberculosis disease not attributed to recent transmission from Northern Africa — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.95 (0.94–0.96) <0.01 Sex Male Ref Ref Ref Female 1.23 (1.09–1.40) <0.01 Birth year 1900–1919* NA NA NA 1920–1939 1.78 (1.08–2.93) 0.02 1940–1959 1.91 (1.32–2.76) <0.01 1960–1979 Ref Ref Ref 1980–1999 0.92 (0.75–1.14) 0.45 2000–2018 9.47 (4.05–22.11) <0.01 Country of birth Algeria Ref Ref Ref Egypt 0.52 (0.39–0.68) <0.01 Morocco 1.10 (0.86–1.40) 0.46 Sudan 0.91 (0.73–1.13) 0.40 Tunisia 3.43 (1.67–7.06) <0.01 Western Sahara 0.23 (0.11–0.46) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations.

Table C6. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US-born persons with tuberculosis disease not attributed to recent transmission from Southern Africa — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.86 (0.85–0.88) <0.01 Sex Male Ref Ref Ref Female 6.47 (5.43–7.70) <0.01 Birth year 1900–1919* NA NA NA 1920–1939 36.21 (17.61–74.44) <0.01 1940–1959 83.52 (47.96–145.46) <0.01 1960–1979 Ref Ref Ref 1980–1999 0.71 (0.54–0.94) 0.02 2000–2018 0.29 (0.17–0.47) <0.01 Country of birth Botswana Ref Ref Ref Namibia 9.87 (6.51–14.96) <0.01 South Africa 0.47 (0.33–0.66) <0.01 Swaziland 20.12 (12.44–32.56) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations.

Table C7. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US-born persons with tuberculosis disease not attributed to recent transmission from Western Africa — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.97 (0.96–0.98) <0.01 Sex Male Ref Ref Ref Female 1.03 (0.96–1.1) 0.37 Birth year 1900–1919 13.21 (4.95–35.28) <0.01 1920–1939 2.24 (1.52–3.31) <0.01 1940–1959 0.66 (0.57–0.76) <0.01 1960–1979 Ref Ref Ref 1980–1999 1.18 (1.04–1.34) <0.01 2000–2018 2.12 (1.50–3.01) <0.01 Country of birth Benin Ref Ref Ref Burkina Faso 1.31 (0.82–2.08) 0.25 Cabo Verde 0.43 (0.29–0.65) <0.01 Côte d’Ivoire 0.94 (0.64–1.39) 0.77 Gambia 1.26 (0.85–1.86) 0.25 Ghana 0.90 (0.62–1.30) 0.57 Guinea 0.99 (0.68–1.45) 0.95 Guinea-Bissau 2.74 (0.94–7.99) 0.07 Liberia 0.72 (0.50–1.04) 0.08 Mali 0.85 (0.56–1.31) 0.47 Mauritania 1.00 (0.63–1.59) 0.98 Niger 1.01 (0.60–1.68) 0.98 Nigeria 0.74 (0.52–1.06) 0.10 Senegal 0.79 (0.54–1.15) 0.22 Sierra Leone 0.62 (0.43–0.89) <0.01 Togo 1.10 (0.70–1.74) 0.68 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. Table C8. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US-born persons with tuberculosis disease not attributed to recent transmission from the Caribbean — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.97 (0.97–0.98) <0.01 Sex Male Ref Ref Ref Female 1.23 (1.21–1.25) <0.01 Birth year 1900–1919 7.64 (5.81–10.05) <0.01 1920–1939 1.47 (1.37–1.58) <0.01 1940–1959 1.11 (1.07–1.15) <0.01 1960–1979 Ref Ref Ref 1980–1999 1.04 (1.00–1.07) 0.05 2000–2018 1.10 (1.01–1.19) 0.03 Country of birth Antigua and Barbuda Ref Ref Ref Bahamas 2.29 (0.99–5.27) 0.05 Barbados 1.92 (0.71–5.20) 0.20 Cuba 4.54 (2.01–10.25) <0.01 Dominica 4.53 (1.80–11.38) <0.01 Dominican Republic 5.89 (2.61–13.32) <0.01 Grenada 6.68 (2.88–15.50) <0.01 Haiti 6.22 (2.75–14.04) <0.01 Jamaica 4.82 (2.13–10.91) <0.01 Saint Lucia 3.77 (1.62–8.76) <0.01 Trinidad and Tobago 3.57 (1.58–8.08) <0.01 Turks and Caicos Islands 4.74 (2.01–11.18) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. Table C9. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US-born persons with tuberculosis disease not attributed to recent transmission from Central America — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.95 (0.94–0.95) <0.01 Sex Male Ref Ref Ref Female 1.07 (1.05–1.08) <0.01 Birth year 1900–1919 1.58 (1.37–1.82) <0.01 1920–1939 1.57 (1.49–1.65) <0.01 1940–1959 1.15 (1.12–1.18) <0.01 1960–1979 Ref Ref Ref 1980–1999 1.06 (1.03–1.09) <0.01 2000–2018 0.99 (0.92–1.08) 0.86 Country of birth Belize Ref Ref Ref Costa Rica 1.58 (1.23–2.03) <0.01 El Salvador 1.89 (1.63–2.19) <0.01 Guatemala 2.09 (1.81–2.43) <0.01 Honduras 2.28 (1.96–2.64) <0.01 Mexico 1.28 (1.10–1.48) <0.01 Nicaragua 1.42 (1.21–1.67) <0.01 Panama 1.40 (1.14–1.72) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value.

Note: country estimates could not be produced for Northern America.

Table C10. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from South America — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.95 (0.95–0.95) <0.01 Sex Male Ref Ref Ref Female 1.08 (1.04–1.12) <0.01 Birth year 1900–1919 6.57 (2.87–15.03) <0.01 1920–1939 0.98 (0.86–1.11) 0.74 1940–1959 0.88 (0.81–0.96) <0.01 1960–1979 Ref Ref Ref 1980–1999 1.11 (1.03–1.20) <0.01 2000–2018 0.86 (0.69–1.07) 0.18 Country of birth Argentina Ref Ref Ref Bolivia (Plurinational State of) 1.05 (0.91–1.21) 0.48 Brazil 1.39 (1.20–1.60) <0.01 Chile 0.63 (0.51–0.78) <0.01 Colombia 1.26 (1.11–1.44) <0.01 Ecuador 1.46 (1.28–1.66) <0.01 Guyana 1.33 (1.14–1.55) <0.01 Paraguay 2.18 (1.40–3.37) <0.01 Peru 1.80 (1.58–2.05) <0.01 Suriname 0.40 (0.15–1.09) 0.07 Uruguay 3.47 (2.68–4.50) <0.01 Venezuela (Bolivarian Republic of) 1.60 (1.37–1.87) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. Table C11. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Central Asia — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 1.14 (1.10–1.19) <0.01 Sex Male Ref Ref Ref Female 0.24 (0.16–0.37) <0.01 Birth year 1900–1919† NA NA NA 1920–1939 0.0003 (0.00006–0.002) <0.01 1940–1959 0.004 (0.001–0.01) <0.01 1960–1979 Ref Ref Ref 1980–1999 2.44 (0.99–6.01) 0.05 2000–2018 NA NA NA Country of birth Kazakhstan Ref Ref Ref Kyrgyzstan 0.98 (0.60–1.61) 0.94 Tajikistan 4.46 (1.43–13.89) <0.01 Turkmenistan 0.26 (0.12–0.57) <0.01 Uzbekistan 0.63 (0.40–0.99) 0.05 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations.

Table C12. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Eastern Asia — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.93 (0.93–0.93) <0.01 Sex Male Ref Ref Ref Female 1.09 (1.06–1.11) <0.01 Birth year 1900–1919 6.79 (5.84–7.90) <0.01 1920–1939 2.55 (2.35–2.76) <0.01 1940–1959 2.02 (1.92–2.13) <0.01 1960–1979 Ref Ref Ref 1980–1999 0.80 (0.76–0.84) <0.01 2000–2018 0.70 (0.56–0.87) <0.01 Country of birth China Ref Ref Ref China, Hong Kong SAR 0.51 (0.48–0.55) <0.01 China, Macao SAR 0.74 (0.53–1.02) 0.07 Democratic People’s Republic of Korea 0.65 (0.62–0.69) <0.01 Japan 0.61 (0.57–0.66) <0.01 Mongolia 1.59 (1.45–1.73) <0.01 Republic of Korea 0.71 (0.69–0.74) <0.01 Taiwan (Republic of China) 0.70 (0.67–0.74) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. Table C13. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from South-eastern Asia — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.93 (0.93–0.93) <0.01 Sex Male Ref Ref Ref Female 1.30 (1.28–1.32) <0.01 Birth year 1900–1919 11.52 (9.77–13.58) <0.01 1920–1939 2.70 (2.55–2.86) <0.01 1940–1959 1.14 (1.10–1.19) <0.01 1960–1979 Ref Ref Ref 1980–1999 0.74 (0.71–0.77) <0.01 2000–2018 0.71 (0.63–0.80) <0.01 Country of birth Cambodia Ref Ref Ref Indonesia 1.01 (0.94–1.08) 0.85 Lao People’s Democratic Republic 1.16 (1.09–1.23) <0.01 Malaysia 1.64 (1.44–1.88) <0.01 Myanmar 1.87 (1.77–1.99) <0.01 Philippines 0.57 (0.55–0.60) <0.01 Singapore 1.23 (0.85–1.76) 0.27 Thailand 1.08 (1.01–1.16) 0.04 Viet Nam 0.99 (0.95–1.04) 0.66 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value.

Table C14. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Southern Asia — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.86 (0.86–0.86) <0.01 Sex Male Ref Ref Ref Female 0.13 (0.13–0.13) <0.01 Birth year 1900–1919 3344.57 (2350.51–4759.02) <0.01 1920–1939 2.35 (2.19–2.53) <0.01 1940–1959 3.15 (2.97–3.34) <0.01 1960–1979 Ref Ref Ref 1980–1999 0.35 (0.33–0.36) <0.01 2000–2018 0.06 (0.05–0.07) <0.01 Country of birth Afghanistan Ref Ref Ref Bangladesh 0.55 (0.51–0.60) <0.01 Bhutan 1.57 (1.40–1.75) <0.01 India 0.49 (0.45–0.53) <0.01 Iran (Islamic Republic of) 1.03 (0.95–1.12) 0.42 Nepal 0.48 (0.44–0.53) <0.01 Pakistan 1.07 (0.98–1.16) 0.13 Sri Lanka 2.37 (1.91–2.96) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value.

Table C15. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Western Asia — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.96 (0.96–0.97) <0.01 Sex Male Ref Ref Ref Female 1.06 (0.99–1.13) 0.12 Birth year 1900–1919 3.26 (1.24–8.55) 0.02 1920–1939 1.17 (0.89–1.52) 0.26 1940–1959 2.29 (1.91–2.75) <0.01 1960–1979 Ref Ref Ref 1980–1999 1.31 (1.16–1.48) <0.01 2000–2018 4.12 (3.09–5.50) <0.01 Country of birth Armenia Ref Ref Ref Azerbaijan 1.95 (1.66–2.29) <0.01 Cyprus 0.15 (0.06–0.37) <0.01 Georgia 1.74 (1.51–2.01) <0.01 Iraq 2.37 (2.08–2.71) <0.01 Israel 0.16 (0.12–0.22) <0.01 Jordan 0.97 (0.75–1.26) 0.84 Kuwait 7.36 (5.54–9.78) <0.01 Lebanon 0.94 (0.75–1.19) 0.62 Qatar 10.03 (7.44–13.53) <0.01 Saudi Arabia 2.04 (1.77–2.36) <0.01 Syria 2.82 (2.36–3.37) <0.01 Turkey 0.84 (0.72–0.97) 0.02 United Arab Emirates 0.96 (0.78–1.19) 0.72 Yemen 1.34 (1.16–1.54) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. Table C16. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Eastern Europe — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.99 (0.99–0.99) <0.01 Male Ref Ref Ref Female 1.01 (0.98–1.04) 0.63 Birth year 1900–1919 0.75 (0.57–0.99) 0.04 1920–1939 0.39 (0.35–0.44) <0.01 1940–1959 0.67 (0.62–0.71) <0.01 1960–1979 Ref Ref Ref 1980–1999 1.22 (1.16–1.29) <0.01 2000–2018 1.28 (1.08–1.53) <0.01 Country of birth Belarus Ref Ref Ref Bulgaria 1.68 (1.45–1.94) <0.01 Czechia 0.07 (0.06–0.08) <0.01 Czechoslovakia 0.38 (0.16–0.90) 0.03 Hungary 1.04 (0.89–1.23) 0.61 Poland 0.79 (0.69–0.91) <0.01 Republic of Moldova 1.40 (1.21–1.61) <0.01 Romania 0.94 (0.82–1.08) 0.36 Russian Federation 1.04 (0.91–1.19) 0.55 Ukraine 1.43 (1.25–1.63) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value.

Table C17. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Northern Europe — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.91 (0.91–0.91) <0.01 Sex Male Ref Ref Ref Female 1.18 (1.13–1.23) <0.01 Birth year 1900–1919* NA NA NA 1920–1939 12.59 (11.22–14.13) <0.01 1940–1959 5.16 (4.86–5.49) <0.01 1960–1979 Ref Ref Ref 1980–1999 3.40 (3.14–3.68) <0.01 2000–2018* NA NA NA Country of birth Denmark Ref Ref Ref Estonia 140.89 (56.99–348.29) <0.01 Finland 2.94 (1.20–7.18) 0.02 Iceland 194.12 (79.28–475.33) <0.01 Ireland 1.46 (0.60–3.57) 0.40 Latvia 28.35 (11.61–69.21) <0.01 Lithuania 145.15 (59.17–356.06) <0.01 Norway† NA NA NA United Kingdom of Great Britain and 4.96 (2.04–12.11) <0.01 Northern Ireland Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations. † Estimate not calculable.

Table C18. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Southern Europe — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.93 (0.93–0.93) <0.01 Sex Male Ref Ref Ref Female 1.52 (1.48–1.57) <0.01 Birth year 1900–1919* NA NA NA 1920–1939 4.04 (3.66–4.47) <0.01 1940–1959 1.89 (1.79–2.00) <0.01 1960–1979 Ref Ref Ref 1980–1999 0.54 (0.51–0.58) <0.01 2000–2018 0.11 (0.09–0.13) <0.01 Country of birth Albania Ref Ref Ref Bosnia and Herzegovina 0.34 (0.32–0.35) <0.01 Croatia 0.43 (0.40–0.47) <0.01 Greece 0.25 (0.24–0.28) <0.01 Italy 0.12 (0.12–0.13) <0.01 Montenegro 0.30 (0.27–0.33) <0.01 North Macedonia 0.71 (0.64–0.78) <0.01 Portugal 0.13 (0.12–0.14) <0.01 Republic of Kosovo† NA NA NA Serbia 0.25 (0.23–0.27) <0.01 Slovenia 0.67 (0.60–0.75) <0.01 Spain 0.87 (0.83–0.91) <0.01 Yugoslavia 0.23 (0.21–0.25) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations. † Estimate not calculable.

Table C19. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Western Europe — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 0.82 (0.82–0.82) <0.01 Sex Male Ref Ref Ref Female 0.39 (0.39–0.40) <0.01 Birth year 1900–1919* NA NA NA 1920–1939 205.80 (196.78–215.23) <0.01 1940–1959 216.70 (209.78–223.86) <0.01 1960–1979 Ref Ref Ref 1980–1999 0.31 (0.30–0.31) <0.01 2000–2018* NA NA NA Country of birth Austria Ref Ref Ref Belgium 0.04 (0.01–0.11) <0.01 France 0.03 (0.01–0.08) <0.01 Germany 0.05 (0.02–0.14) <0.01 Netherlands 0.19 (0.06–0.54) <0.01 Switzerland 0.02 (0.01–0.06) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations.

Table C20. Adjusted hazard ratio (aHR) estimates of tuberculosis disease onset for non–US- born persons with tuberculosis disease not attributed to recent transmission from Oceania — United States, 2011–2018

Characteristic aHR 95% CI p value Age (yrs) 1.01 (1.00–1.01) 0.20 Sex Male Ref Ref Ref Female 0.78 (0.70–0.88) <0.01 Birth year 1900–1919* NA NA NA 1920–1939 0.13 (0.06–0.29) <0.01 1940–1959 1.66 (1.37–2.02) <0.01 1960–1979 Ref Ref Ref 1980–1999 3.14 (2.46–4.01) <0.01 2000–2018 11.97 (7.27–19.71) <0.01 Country of birth Australia Ref Ref Ref Cook Islands 1211.18 (487.23–3010.81) <0.01 Fiji 17.26 (8.15–36.55) <0.01 Marshall Islands 92.87 (44.74–192.81) <0.01 Micronesia (Federated States of) 97.33 (46.14–205.34) <0.01 Nauru 214.34 (70.43–652.29) <0.01 Palau 180.09 (59.45–545.48) <0.01 Papua New Guinea† NA NA NA Pitcairn 15.98 (7.26–35.15) <0.01 Samoa 8.30 (4.02–17.13) <0.01 Tokelau 1.33 (0.66–2.70) 0.43 Tonga 12.28 (6.05–24.93) <0.01 Abbreviations: CI: confidence interval; NA: not available; Ref: reference value. * No observations. † Estimate not calculable.

Figure C1. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons stratified by age — United States, 2011–2018.

Figure C2. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons stratified by birth year — United States, 2011– 2018.

Figure C3. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons stratified by sex — United States, 2011–2018.

Reference

C1. United Nations Statistics Division. Standard country or area codes for statistical use (M49) [Internet]. New York: United Nations; [cited 2020 March 2]. https://unstats.un.org/unsd/methodology/m49/

APPENDIX D KAPLAN-MEIER ESTIMATES OF HEALTH ORGANIZATION HIGH TUBERCULOSIS BURDEN COUNTRIES (D1) REPRESENTED IN THIS STUDY (UNITED NATIONS M49 NAMES AS OF JANUARY 2020 [D2])

Figure D1. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in Eastern Africa — United States, 2011–2018.

Figure D2. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in Middle Africa — United States, 2011–2018. (Note: Zaire was included under Congo, Democratic Republic of the.)

Figure D3. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in Southern Africa — United States, 2011–2018.

Figure D4. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in Western Africa — United States, 2011–2018.

Figure D5. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in South America — United States, 2011–2018.

Figure D6. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in Eastern Asia — United States, 2011–2018.

Figure D7. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in South-eastern Asia — United States, 2011–2018. (Note: Burma was included under Myanmar.)

Figure D8. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in Southern Asia — United States, 2011–2018.

Figure D9. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in Eastern Europe — United States, 2011–2018

Figure D10. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–U.S.-born persons from World Health Organization high TB burden countries in Oceania — United States, 2011–2018.

References

D1. World Health Organization. Global tuberculosis report 2019 [Internet]. Geneva: World Health Organization; 2019 [cited 2020 February 26]. https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1

D2. United Nations Statistics Division. Standard country or area codes for statistical use (M49) [Internet]. New York: United Nations; [cited 2020 March 2]. https://unstats.un.org/unsd/methodology/m49/

APPENDIX E KAPLAN-MEIER ESTIMATES FOR TOP 10 COUNTRIES OF BIRTH FOR NUMBER OF TUBERCULOSIS CASES IN 2018 IN THE UNITED STATES (D1) (UNITED NATIONS M49 NAMES AS OF JANUARY 2020 [D2])

Figure E. Kaplan-Meier estimates for time to tuberculosis (TB) disease diagnosis not attributed to recent transmission for non–US-born persons by top 10 countries of birth for number of TB cases in 2018 in the United States — United States, 2011–2018

References

D1. Centers for Disease Control and Prevention (CDC)/Division of Tuberculosis Elimination. Table 19. Tuberculosis cases and percentages among non–U.S.-born persons, by the top 30 countries of birth and years in the United States before TB diagnosis: United States, 2018 [Internet]. Atlanta, GA: US Department of Health and Human Services, CDC; 2019 [cited 2020 April 13]. https://www.cdc.gov/tb/statistics/reports/2018/table19.htm

D2. United Nations Statistics Division. Standard country or area codes for statistical use (M49) [Internet]. New York: United Nations; [cited 2020 March 2]. https://unstats.un.org/unsd/methodology/m49/