Targeted screening for tuberculosis infection in priority populations in Guangzhou, China: IGRA positivity, associated factors, and risk interactions
4 affiliations
- 1Key Laboratory of Tuberculosis Control, Department of Tuberculosis Control and Management, Guangzhou Chest Hospital, Guangzhou, Guangdong 510095 China
- 2First Outpatient Department, Guangzhou Chest Hospital, Guangzhou, Guangdong 510095 China
- 3Zhongcun Street Community Health Service Center, Panyu District, Guangzhou, Guangdong 511400 China
- 4Department of Tuberculosis Prevention and Control, Zengcheng District Center for Disease Control and Prevention, Guangzhou, Guangdong 511300 China
Abstract
Background: Community tuberculosis screening programmes in China prioritise several population groups, but interferon-gamma release assay (IGRA) positivity and its associated factors may differ substantially across groups. We assessed IGRA positivity among residents screened in 11 programme communities in Guangzhou and examined patterns in the school population, older adults, and people with self-reported diabetes.
Methods: We analysed cross-sectional screening data from 12,299 participants using site-clustered GEE for multivariable and stratified analyses, and evaluated three hypothesis-driven exploratory interactions on the multiplicative and OR-based additive scales with simulation-based confidence intervals. Sensitivity analyses excluded participants with prior tuberculosis and applied Firth penalised logistic regression to the sparse diabetes × tuberculosis-contact interaction.
Results: Overall IGRA positivity was 14.48% (1,781/12,299). Positivity was 5.32% (254/4,771) among students, 11.83% (117/989) among school staff, 23.44% (1,019/4,348) among adults aged ≥ 60 years, and 32.96% (614/1,863) among people with self-reported diabetes. In the site-clustered model, male sex, older age, reported tuberculosis contact, prior tuberculosis, self-reported diabetes, other comorbidities, and suspected tuberculosis symptoms were associated with IGRA positivity. Positive interactions were observed for diabetes × male sex (RERI 2.63, 95% CI 1.82–3.56), diabetes × tuberculosis contact (RERI 20.75, 95% CI 4.14–70.72), and male sex × older age (RERI 1.25, 95% CI 0.82–1.73). For diabetes × tuberculosis contact, the multiplicative interaction remained significant in the non-clustered Firth analysis (OR 3.41, 95% CI 1.27–11.29; P = 0.014).
Conclusions: IGRA positivity differed substantially across programme groups. The findings support prioritising people with diabetes and recent tuberculosis contact, older adults with additional risk factors, and exposed students and school staff for clinical evaluation. The interaction findings were exploratory and should not be interpreted as causal effects.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28968-9.
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BibTeX
@article{feng2026targeted,
title = {{Targeted screening for tuberculosis infection in priority populations in Guangzhou, China: IGRA positivity, associated factors, and risk interactions}},
author = {Yajuan Feng and Xiaoshan Lin and Yuting Cai and Huamei Feng and Fang Gong and Keng Lai},
journal = {BMC Public Health},
year = {2026},
month = aug,
doi = {10.1186/s12889-026-28968-9},
url = {https://doi.org/10.1186/s12889-026-28968-9},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Targeted screening for tuberculosis infection in priority populations in Guangzhou, China: IGRA positivity, associated factors, and risk interactions
AU - Yajuan Feng
AU - Xiaoshan Lin
AU - Yuting Cai
AU - Huamei Feng
AU - Fang Gong
AU - Keng Lai
PY - 2026
DA - 2026/08/11
JO - BMC Public Health
DO - 10.1186/s12889-026-28968-9
UR - https://doi.org/10.1186/s12889-026-28968-9
AB - Background: Community tuberculosis screening programmes in China prioritise several population groups, but interferon-gamma release assay (IGRA) positivity and its associated factors may differ substantially across groups. We assessed IGRA positivity among residents screened in 11 programme communities in Guangzhou and examined patterns in the school population, older adults, and people with self-reported diabetes. Methods: We analysed cross-sectional screening data from 12,299 participants using site-clustered GEE for multivariable and stratified analyses, and evaluated three hypothesis-driven exploratory interactions on the multiplicative and OR-based additive scales with simulation-based confidence intervals. Sensitivity analyses excluded participants with prior tuberculosis and applied Firth penalised logistic regression to the sparse diabetes × tuberculosis-contact interaction. Results: Overall IGRA positivity was 14.48% (1,781/12,299). Positivity was 5.32% (254/4,771) among students, 11.83% (117/989) among school staff, 23.44% (1,019/4,348) among adults aged ≥ 60 years, and 32.96% (614/1,863) among people with self-reported diabetes. In the site-clustered model, male sex, older age, reported tuberculosis contact, prior tuberculosis, self-reported diabetes, other comorbidities, and suspected tuberculosis symptoms were associated with IGRA positivity. Positive interactions were observed for diabetes × male sex (RERI 2.63, 95% CI 1.82–3.56), diabetes × tuberculosis contact (RERI 20.75, 95% CI 4.14–70.72), and male sex × older age (RERI 1.25, 95% CI 0.82–1.73). For diabetes × tuberculosis contact, the multiplicative interaction remained significant in the non-clustered Firth analysis (OR 3.41, 95% CI 1.27–11.29; P = 0.014). Conclusions: IGRA positivity differed substantially across programme groups. The findings support prioritising people with diabetes and recent tuberculosis contact, older adults with additional risk factors, and exposed students and school staff for clinical evaluation. The interaction findings were exploratory and should not be interpreted as causal effects. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28968-9.
SN - 1471-2458
ER -