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August 25, 1993

Risk of Tuberculosis and Time Spent in Jail

JAMA. 1993;270(8):940. doi:10.1001/jama.1993.03510080044025

To the Editor.  —Bellin et al1 followed a cohort of inmates in the New York City jail system who at entry were nonreactive to a Mantoux tuberculin skin test, and suggest that the subsequent incidence of active tuberculosis (TB) in the cohort proves an association of TB disease with either jail time or number of jail admissions. Several methodologic issues should be clarified before this plausible hypothesis can be accepted.For example, ascertainment of TB cases was likely incomplete, since matching was done only to the New York City TB registry. Thousands of New York City jail inmates are transferred yearly to the New York State Department of Correctional Services (NYSDOCS); active TB in NYSDOCS inmates are registered with the New York State Department of Health, not with New York City. Since most NYSDOCS inmates (85%) are from New York City,2 there were likely to be several cases of