Brief communication Social and clinical predictors of drug-resistant tuberculosis in a public hospital, Monterrey, Mexico Bonnie N. Young PhD, MPH a, * , Marcos Burgos MD b , Alexis J. Handal PhD, MPH c , Jack Baker PhD d , Adrian Rendón MD e , Adrian Rosas-Taraco PhD f , Jeffrey Long PhD a , Keith Hunley PhD a a Department of Anthropology, University of New Mexico, Albuquerque b Department of Internal Medicine, University of New Mexico, Albuquerque c Department of Family and Community Medicine, University of New Mexico, Albuquerque d Geospatial and Population Studies, Institute for Applied Research Services, University of New Mexico, Albuquerque e Tuberculosis Clinic, Pulmonary Services and Clinical Pathology Laboratory, Hospital Universitario José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico f Department of Immunology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico article info Article history: Received 8 April 2014 Accepted 3 July 2014 Available online 10 July 2014 Keywords: Tuberculosis Drug resistance Mexico Urban hospitals Case-control studies abstract Purpose: Drug-resistant tuberculosis (DRTB) is steadily increasing in Mexico, but little is known of patient risk factors in the MexicoeUnited States border region. This preliminary case-control study included 95 patients with active pulmonary TB with drug susceptibility results attending the José E. González University Hospital in the urban hub of Nuevo Leóndthe Monterrey Metropolitan Area. We report potential social and clinical risk factors of DRTB among this hospital-based sample. Methods: We collected data through face-to-face interviews and medical record reviews from 25 cases with DRTB and 70 drug-sensitive controls. DNA was collected to assess an effect of genetic ancestry on DRTB by using a panel of 291,917 genomic markers. We calculated crude and multivariate logistic regression. Results: After adjusting for potential confounding factors, we found that prior TB treatment (odds ratio, 4.5; 95% confidence interval, 0.9e21.1) and use of crack cocaine (odds ratio, 4.6; 95% confidence interval, 1.1e18.7) were associated with DRTB. No other variables, including genetic ancestry and comorbidities, were predictive. Conclusions: Health care providers may benefit from recognizing predictors of DRTB in regions where routine drug susceptibility testing is limited. Prior TB treatment and illicit drug use, specifically crack cocaine, may be important risk factors for DRTB in this region. Ó 2014 Elsevier Inc. All rights reserved. Introduction Drug-resistant tuberculosis (DRTB) is increasing along the MexicoeUnited States border region, but little is known about patient risk factors [1,2]. Previous research has highlighted the concern of DRTB in this region and called for a better understanding of the predictors of drug resistance [1,3,4]. Nuevo León, one of six Mexican states bordering the United States, has the second highest prevalence of DRTB cases [5]. More than 90% of TB cases in Nuevo León occur in its urban center, the Monterrey Metropolitan Area (MMA), located 140 miles southwest of Laredo, Texas. The MMA is the third most populous metropolitan area in Mexico with approximately 4 million inhabitants. Recent studies have reported extensive drug resistance in the MMA [6], particularly among cases that have been previously treated with anti-TB drugs [3]. Because of the selective use of resources in Mexico, testing of suspect TB cases in the general population is limited to acid-fast bacilli smears. In most hospitals, routine cultures and drug sus- ceptibility testing are not conducted, rather, they are often reserved for special case situations, such as if drug resistance is suspected from initial treatment failure [7]. Given financial constraints that prohibit routine cultures and drug susceptibility testing (DST) within most hospitals, health care providers may benefit from identifying patient risk factors for drug resistance. To this end, we explored the role of social factors and clinical measures on DRTB among a hospital-based sample of pulmonary TB patients in the MMA. Conflicts of interest: None. * Corresponding author. Department of Anthropology, University of New Mexico, MSC01-1040, Albuquerque, NM 87131. Tel.: þ1 505 688 9110; fax: þ1 808 861 8532. E-mail address: byoung@unm.edu (B.N. Young). Contents lists available at ScienceDirect Annals of Epidemiology journal homepage: www.annalsofepidemiology.org 1047-2797/$ e see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.annepidem.2014.07.001 Annals of Epidemiology 24 (2014) 771e775