In a case-control study of 92 Indian patients, 46 with active tuberculosis (cases) and 46 tuberculin reactors without the disease (control subjects), significantly more control subjects than patients had prior adequate isoniazid chemoprophylaxis. While the Indian Health Service recommends treating all tuberculin reactors with isoniazid prophylaxis, most (75%) of our tuberculosis (TB) cases could have been prevented if the guidelines of the American Thoracic Society had been followed. Diabetes, alcohol abuse, and chronic renal failure were risk factors for active TB. Despite marked reductions in TB morbidity and mortality rates among American Indians and Alaska Natives over the past 30 years, their TB rates are still two to three times higher than overall United States and white rates. Enhanced TB control programs with an emphasis on preventive therapy for patients at risk for developing active disease, especially those with diabetes and chronic renal failure, could decrease the incidence and eventually eliminate TB among American Indians and Alaska Natives.
(Arch Intern Med. 1992;152:547-550)