Online
Tuberculosis Information System (OTIS)
Technical
Reference
January 2008
Summary: The Online Tuberculosis Information System
(OTIS) contains information on verified tuberculosis (TB) cases reported to the
Centers for Disease Control and Prevention (CDC) by state health departments,
the District of Columbia and Puerto
Rico from 1993 through 2006.
These data were extracted from the CDC national TB surveillance
system. Data for 22 variables are
included in the data set and users are able to produce cross-tabulations with
multi-level stratification. The data are
updated on a regular basis.
Population: All
persons reported as TB cases, 1993 through 2006
Source:
Online Tuberculosis Information System (OTIS), National Tuberculosis Surveillance
System, United States, 1993-2006. U.S.
Department of Health and Human Services (US DHHS), Centers for Disease
Control and Prevention (CDC), CDC WONDER On-line Database, January 2008.
In WONDER: Users can
select criteria to produce cross-tabulated incidence counts. Data are organized into three levels of
geographic detail: national, state and
Metropolitan Statistical Areas (MSAs)
Introduction
The technical notes
provide a detailed description of OTIS--its background, the variables and data
limitations--as well as the procedures involved in processing the data. The topics covered include the following:
1.
Purpose and Intended Audience of OTIS
2.
Assurance of Confidentiality
3.
Confidentiality Procedures
4.
Introduction to Data
5.
Surveillance for TB
a.
History of National TB Surveillance Data
b.
Case Definition
c.
Case Count
d.
Report of a Verified Case of TB
e.
Completeness and Accuracy of TB Surveillance Data
6.
Data Dictionary
a.
MSAs with population greater than or equal to 500,000 persons, 1993-2005
b.
Description and Coding of Variables Chart
7.
Caveats to Use of Data
a.
Race/Ethnicity Variable
b.
Site of Disease Variable -- Miliary Disease Adjustment
c.
Reporting of HIV Infection
d.
Completeness of HIV Data
e.
Clinical and Treatment Variables -- MDR-TB, COT, DOT
i.
Multidrug-Resistant TB (MDR-TB)
ii.
Completion of Therapy (COT)
iii.
Directly-Observed Therapy (DOT)
8.
Determination of Population for Rate Calculation
9.
Link to Glossary of TB Terms
10.
References
1. Purpose and Intended Audience of OTIS
OTIS
provides data on verified cases of TB reported by the 50 states, Washington, D.C. and Puerto Rico health departments to the Centers for Disease
Control and Prevention (CDC) Division of TB Elimination (DTBE). These data are intended for a broad
audience-- the public, public health practitioners, researchers, and public
health officials-- to increase their knowledge of TB and further the use and
accessibility of national TB surveillance data.
OTIS will enable users to query TB case rates at the national level and
TB case counts of demographic, risk factor, clinical, and outcome information
at the national, state, and metropolitan statistical area (MSA) levels of
geographic detail. In addition, the TB
data will help federal, state, and local public health officials design
programs, target persons at risk, and provide reliable data for program and
policy decisions.
Note: State and
local health departments have the most up-to-date and complete data making them
the best source for local inquiries; therefore if an OTIS user is interested in
further state-specific information, he/she should contact the health department
of that particular state. If an OTIS
user has any other questions or concerns, he/she can contact the WONDER help
desk at cwus@cdc.gov, or call (888) 496-8347.
2.
Public Release Disclosure Statement
The data for OTIS contain information abstracted from
the national tuberculosis (TB) case report form called the Report of Verified
Case of Tuberculosis (RVCT) (OMB No. 0920-0026). These data have been reported voluntarily to
CDC by state and local health departments, and are protected under the
Assurance of Confidentiality (Sections 306 and 308(d) of the Public Health
Service Act, 42 U.S.C. 242k and 242m(d)), which prevents disclosure of any information
that could be used to directly or indirectly identify patients. The data on OTIS are being released for
public use in accordance with the Assurance and do not identify patients
directly, nor do they contain information that can identify patients indirectly. Any effort to determine the identity of any
reported cases, or to use the information for any purpose other than
statistical reporting and analysis, is a violation of the Assurance. Therefore, users will
·
Use the data for statistical reporting
and analysis only.
·
Make no attempt to learn the identity of
any person or establishment included in these data.
·
Make no disclosure or other use of the
identity of any person or establishment discovered inadvertently, and advise
the
Associate Director for Science,
Office of Science Policy and Technology Transfer,
CDC, Mail stop D-50,
1600 Clifton Road, N.E.
Atlanta, Georgia 30333
Phone: 404-639-7240
and the relevant state or public health agency, of such a discovery.
·
Data users should not state or imply
interpretations of the data analysis are attributable to the Centers for
Disease Control and Prevention unless they are collaborating with CDC personnel
on the analysis of the data and have written permission from their CDC
collaborators to state or imply attribution to CDC.
For more information, see the CDC/ATSDR Policy on
Releasing and Sharing Data (at http://www.cdc.gov/od/foia/policies/sharing.htm).
Suggested
citation for OTIS data users:
CDC. Online Tuberculosis Information System, National
Tuberculosis Surveillance System, United States, 1993-2006. Available at URL
http://wonder.cdc.gov/tb.html xxx, date accessed.
3.
Confidentiality Procedures
In accordance with CDC guidelines, confidentiality
procedures were determined through careful examination of data by DTBE staff
and state TB data providers.
Aggregation, the grouping of continuous variables into specific
intervals, is the main technique used by DTBE to protect the confidentiality of
the national TB surveillance data. OTIS
users will have the ability to query demographic and risk factor variables at
the state and MSA levels for two different time intervals by year of reporting,
"previous 5 years" (2001-2006) and “14 years” (all years included in
data set, 1993-2006). Cell suppression
is applied to count values less than or equal to three (3) at the state and the
metropolitan (MSA) level. Cell suppression is not applied at the state level
when the cell represents values for the total cases reported by a state within
a time period of one or more years. Rates are only available at the national
level. Demographic and risk factor
variables include the following: Sex;
Race/Ethnicity; Country of Birth; Broad Age Groups; Standard Age Groups; HIV
Status; Resident of a Long-term Care Facility; Resident of a Correctional
Facility; Homeless; Occupation; Injecting Drug Use; Non-injecting Drug Use;
Excessive Use of Alcohol. Data for
these variables are not available at the state or MSA levels for individual
years. However, OTIS users will be able
to query single year data for all other variables at all geographic levels.
In addition, the following data is suppressed in
respect to the policies of our partners:
·
Louisiana HIV
data: All HIV data from the state of
Louisiana is
suppressed when shown at the state or metropolitan (MSA) level. HIV data for Louisiana is included at
the national level.
4.
Introduction to Data
The
Online Tuberculosis Information System (OTIS) contains information reported to
the Centers for Disease Control and Prevention (CDC) on verified TB cases in
the United States
from 1993 through 2006. Individual TB
case information is collected at the local and state levels and transmitted
electronically to CDC. The reporting
areas are funded by DTBE through cooperative agreements to collect individual
case data for surveillance purposes.
Individual case data are collected using the RVCT form, which contains
demographic and diagnostic information, the results of TB drug susceptibility
testing, risk factors for TB disease, and treatment outcomes.
5.
Surveillance for TB
History
of National TB Surveillance Data
TB is a nationally notifiable disease and
reporting is mandated by state and local public health law in all states. In 1953, a national surveillance system was
established to collect information on cases of active TB. Since 1985, all states report TB cases to
CDC using the RVCT. In 1993, DTBE, in
conjunction with state and local health departments, implemented an expanded TB
surveillance system. As part of the
expanded system, a software package, the Surveillance Software for Tuberculosis
(SURVS‑TB), was designed and implemented for data entry, analysis, and
transmission of case reports to CDC. In
1998, the Tuberculosis Information Management System (TIMS), a windows-based
information system, replaced SURVS-TB.
Case Definition
A verified case of TB for public health surveillance
may be laboratory confirmed or, in the absence of laboratory confirmation, meet
the clinical case definition.1
The criteria for determining a laboratory confirmed case are 1)
isolation of M. tuberculosis from a
clinical specimen; 2) demonstration of M.
tuberculosis from a clinical specimen by nucleic acid amplification test;
or 3) demonstration of acid-fast bacilli in a clinical specimen when a culture
has not been or cannot be obtained.
A clinically verified case of TB meets all of the
following criteria: 1) a positive tuberculin skin test; 2) other signs or
symptoms compatible with TB, such as an abnormal, unstable (worsening or
improving) chest x-ray, or clinical evidence of current disease; 3) treatment
with two or more antituberculosis medications; and 4)
a completed diagnostic evaluation.
Case
Count
A case is counted only once within any consecutive
12-month period.2 However, a
patient who had verified disease in the past is counted again if the case was
discharged from supervision (e.g., completed antituberculosis
therapy) or lost to supervision for more than 12 months and disease can be
verified again. The case is not counted
a second time if 12 months have not passed since the case was discharged from
supervision. Mycobacterial
diseases other than those caused by M.
tuberculosis complex are not counted in tuberculosis morbidity statistics
unless there is concurrent M.
tuberculosis.
CDC's national morbidity reports have traditionally
counted all cases; those that meet the standard published case definition and
those that are verified by the reporting areas. When the standard case definition is not met,
areas are given the option of verifying using other sets of local criteria such
as contact to an infectious case or immunosuppression
status. In this circumstance, the
criteria used to verify the case of TB are categorized as “Provider Diagnosis.”
For
more information see Recommendations for Counting Reported Tuberculosis Cases (http://www.cdc.gov/tb/surv/surv2002/PDF/AppendixC.pdf).
Report of a Verified Case of Tuberculosis
From 1985 through 1992 verified cases of TB were
reported to CDC using the Report of Verified Case of Tuberculosis (RVCT) form
(OMB No. 0920-0026). Some health
departments, however, reported cases in the format of the RVCT via magnetic
tape, diskette, and/or remote bulletin board.
From 1993 to 1997, all data were reported using the expanded RVCT form,
entered into SURVS-TB, and transferred to CDC via diskettes. Since 1998, data have been transferred to CDC
via TIMS. Identifying information, such
as the patient's name, address, and Social Security Number (SSN) are retained
at the state and local level. CDC does
not receive names, addresses, or SSN of persons reported as TB cases. In the future it is anticipated that RVCT
data will be received via the Public Health Information Network (PHIN)/National
Electronic Disease Surveillance System (NEDSS).
Completeness and
Accuracy of TB Surveillance Data
Formal evaluation of the completeness and accuracy of
TB data assists health departments in developing strategies to improve the
completeness of reporting, communicate with reporting sources, correct
deficiencies in health-care provider knowledge about reporting TB, and improve
evaluation of suspect TB cases. Formal
evaluations of TB surveillance have found the completeness of reporting of TB
cases to state health departments varies a great deal, depending on the type
and jurisdiction of the study.3
For example, a 1993-1994 multi-site study found reporting to be greater
than 95%4, while other studies found ranges of completeness between
40% and 80% depending on the methodology used. 5-9
Data completeness is essential for producing annual
surveillance reports and generating official TB statistics. DTBE
takes a number of steps to ensure that the RVCT information received through
TIMS from the states is both complete and high quality. Throughout
the year, DTBE surveillance staff generate internal reports which include
frequencies and cross tabulations on certain variables. The staff
then evaluate the data for quality (e.g., do the data make sense and are any
conflicting data present) and contact states when inconsistencies exist.
States then have the opportunity to review the case and update the
data in TIMS. In addition, DTBE finalizes its TB case counts once
a year. These data are published in the annual TB surveillance
report (http://www.cdc.gov/tb/surv/)
and other official publications. As
part of the process for finalizing the case count, DTBE staff consider the
percentages of data that are unknown or missing, and follow up with states
that exceed predetermined levels of data incompleteness that are
specific to each variable.
If acceptable levels of completeness for risk factors, treatment
and clinical variables are not attained, those data will not be published
in the annual DTBE surveillance report.
When
analyzing OTIS data, consider the following completeness issues:
·
New York City risk factor data (with the exception of Resident of
a Correctional Facility variable) for 1993 are almost completely unknown.
·
At the national
level, risk factor data for most reporting areas have greater than 10 percent
missing and unknown for 1993 and 1994 for Resident of Long-term Care Facility
and Homeless variables.10
·
At the national
level, risk factor data for most reporting areas have greater than 10 percent
missing and unknown from 1993 through 1997 for Injecting Drug Use,
Non-injecting Drug Use, Excessive Alcohol Use, HIV Status and Occupation.10
·
Completion of
therapy data and directly observed therapy data are reported from 1993 through
2004. Because states have up to two years to report these types of data they
lag 2 years behind the current report year.
Note: A discussion
of the completeness of HIV data is in Section 8.
In addition to the completeness of case reporting,
the accuracy of the information collected (e.g., individual elements) on the
RVCT is also very important. To date,
little research exists on this topic; however, the California Department of
Health Services is studying the validity of data collected on the RVCT and has
found that most California TB surveillance data have a range of concordance
from 18 to 98 percent. For more
information about the preliminary findings and recommendations, refer to the
abstract referenced.11
6.
Data Dictionary
State All 50 states, the District
of Columbia, and Puerto Rico
MSA MSAs with a 2006 population
greater than or equal to 500,000 persons (See list below.) Metropolitan statistical areas are defined
by the federal Office of Management and Budget (OMB). The MSA definitions apply to all areas except
the six New England
states; for these states, the New England County Metropolitan Areas (NECMAs) are used.
Metropolitan areas are named for a central
city in the MSA or NECMA, may include several cities and counties, and may
cross state boundaries. Further
information about MSAs can be found on the U.S.
Census Bureau website (http://www.census.gov/population/www/estimates/metro_general/2006/List4.txt). State and
MSA data are based on the patient's residence at the time of TB diagnosis.
MSAs greater than or equal to 500,000 population, 2006
|
Akron, OH
|
Greenville, SC
|
Pittsburgh, PA
|
|
Albany-Schenectady, NY
|
Harrisburg, PA
|
Portland-Biddeford, ME
|
|
Albuquerque, NM
|
Hartford, CT
|
Portland, OR
|
|
Allentown, PA
|
Honolulu, HI
|
Poughkeepsie, NY
|
|
Atlanta, GA
|
Houston, TX
|
Providence, RI
|
|
Augusta-Richmond, GA-SC
|
Indianapolis, IN
|
Raleigh-Cary, NC
|
|
Austin-Round Rock, TX
|
Jackson, MS
|
Richmond, VA
|
|
Bakersfield, CA
|
Jacksonville, FL
|
Riverside-San Bern., CA
|
|
Baltimore, MD
|
Kansas City, MO
|
Rochester, NY
|
|
Baton Rouge, LA
|
Knoxville, TN
|
Sacramento, CA
|
|
Birmingham-Hoover, AL
|
Lakeland, FL
|
St. Louis, MO-IL
|
|
Boise City-Nampa, ID
|
Las Vegas, NV
|
Salt Lake City, UT
|
|
Boston, MA
|
Little Rock, Ark
|
San Antonio, TX
|
|
Bridgeport, CT
|
Los Angeles, CA
|
San Diego, CA
|
|
Buffalo, NY
|
Louisville, KY
|
San Francisco, CA
|
|
Cape Coral, FL
|
Madison, WI
|
San Jose, CA
|
|
Charleston, SC
|
McAllen, TX
|
Sarasota, FL
|
|
Charlotte, NC
|
Memphis, TN
|
Seattle, WA
|
|
Chicago, IL
|
Miami, FL
|
Scranton, PA
|
|
Cincinnati, OH
|
Milwaukee, WI
|
Springfield, MA
|
|
Cleveland, OH
|
Minneapolis-St.Paul, MN
|
Stockton, CA
|
|
Colorado Springs, CO
|
Modesto, CA
|
Syracuse, NY
|
|
Columbus, OH
|
Nashville, TN
|
Tampa-St. Petersburg, FL
|
|
Columbia, SC
|
New Haven, CT
|
Toledo, OH
|
|
Dallas, TX
|
New Orleans, LA
|
Tucson, AZ
|
|
Dayton, OH
|
New York, NY
|
Tulsa, OK
|
|
Denver, CO
|
Oklahoma City, OK
|
Virginia Beach, VA
|
|
Des Moines, IA
|
Omaha-Council Bluffs, NE-IA
|
Washington, DC
|
|
Detroit, MI
|
Orlando-Kissimmee, FL
|
Wichita, KS
|
|
El Paso, TX
|
Oxnard-Ventura, CA
|
Worchester, MA
|
|
Fresno, CA
|
Palm Bay, FL
|
Youngstown, OH
|
|
Grand Rapids, MI
|
Philadelphia, PA
|
|
|
Greensboro, NC
|
Phoenix, AZ
|
|
Description and
Coding of Variables Chart
Variable definitions can be found
in the TIMS User's Guide, Appendix SUR I -RVCT Form Completion Instructions ( ftp://ftp.cdc.gov/pub/software/TIMS/Documentation/Apx%20SUR%20I%20RVCT%20Form%20Completion%20Instructions.pdf).
| Variable
|
Description
|
Coding Scheme
|
|
Criteria Used to Verify a TB Case
|
Groups cases based on the criteria used to
determine which part of the case definition was used to verify cases.
|
Positive culture result
Positive smear/tissue result
Clinical case definition
Provider diagnosis
|
|
Year TB Case Was Counted
|
Year the case was verified and submitted to the CDC
as part of the official case count.
|
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
|
|
Years Since Arrival in US (Foreign-born only)
|
For foreign-born cases, the number of years since
arrival in the U.S.
|
<1 year
1- 4 years
5- 14 years
≥ 15 years
Unknown
|
|
Sex
|
Biological sex of the patient.
|
Male
Female
Unknown
|
|
Race/Ethnicity
|
Calculated by combining race and ethnic origin
variables into categories to determine the patient's self-identified racial
and ethnic category. Persons of
Hispanic origin can be of any race.
All other categories are non-Hispanic, single race.
In 2003 and 2004, the Asian
or Pacific Islander category contains cases among persons who self-reported
race as Asian only or Native Hawaiian or other Pacific Islander only. TB cases of multiple race consist of less
than 1% of all cases, and for 2003 and 2004 are categorized as Unknown.
|
White, Non-Hispanic
Black, Non-Hispanic
Hispanic, All Races
American Indian or
Alaska Native
Asian or Pacific Islander
Unknown
|
| Variable
|
Description
|
Coding Scheme
|
|
Country of Birth
|
Indicates if patient is U.S. or foreign-born. Foreign-born refers to persons born outside
the United States
and its possessions and dependencies.
Exceptions include persons born overseas to U.S. citizens, on military bases,
etc.
|
U.S.-born
Foreign-born
Unknown
|
|
Broad Age Groups
|
Indicates age group
of patient at time of case report. Age
groups are based on the patient's age in the month and year the patient was
reported to the health department as a suspected case.
|
0-4 years old
5-14 years old
15-24 years old
25-44 years old
45-64 years old
≥ 65 years old
Unknown
|
|
Standard Age Groups (U.S.
Census Bureau)
|
Age group of patient
at time of case report. Age groups are
based on the patient's age in the month and year the patient was reported to
the health department as a suspected case.
|
<1 years old
|
