BACKGROUND The epidemiological impact and cost-effectiveness of social protection and biomedical interventions for tuberculosis-affected households might be improved by risk stratification. We therefore derived and externally validated a household-level risk score to predict tuberculosis among contacts of patients with tuberculosis. METHODS In this prospective cohort study, we recruited tuberculosis-affected households from 15 desert shanty towns in Ventanilla and 17 urban communities in Callao, Lima, Peru. Tuberculosis-affected households included index patients with a new diagnosis of tuberculosis and their contacts who reported being in the same house as the index patient for more than 6 h per week in the 2 weeks preceding index patient diagnosis. Tuberculosis-affected households were not included if the index patient had no eligible contacts or lived alone. We followed contacts until 2018 and defined household tuberculosis, the primary outcome, as any contact having any form of tuberculosis within 3 years. We used logistic regression to identify characteristics of index patients, contacts, and households that were predictive of household tuberculosis, and used these to derive and externally validate a household-level score. FINDINGS Between Dec 12, 2007, and Dec 31, 2015, 16 505 contacts from 3 301 households in Ventanilla were included in a derivation cohort. During the 3-year follow-up, tuberculosis occurred in contacts of index patients in 430 (13%, 95% CI 12-14) households. Index patient predictors were pulmonary tuberculosis and sputum smear grade, age, and the maximum number of hours any contact had spent with the index patient while they had any cough. Household predictors were drug use, schooling of the female head of a household, and lower food spending. Contact predictors were if any of the contacts were children, number of lower-weight (body-mass index [BMI] <20·0 kg/m2) adult contacts, number of normal-weight (BMI 20·0-24·9 kg/m2) adult contacts, and number of past or present household members who previously had tuberculosis. In this derivation cohort, the score c statistic was 0·77 and the risk of household tuberculosis in the highest scoring quintile was 31% (95% CI 25-38; 65 of 211) versus 2% (95% CI 0-4; four of 231) in the lowest scoring quintile. We externally validated the risk score in a cohort of 4248 contacts from 924 households in Callao recruited between April 23, 2014, and Dec 31, 2015. During follow-up, tuberculosis occurred in contacts of index patients in 120 (13%, 95% CI 11-15) households. The score c statistic in this cohort was 0·75 and the risk of household tuberculosis in the highest scoring quintile was 28% (95% CI 21-36; 43 of 154) versus 1% (95% CI 0-5; two of 148) in the lowest scoring quintile. The highest-scoring third of households captured around 70% of all tuberculosis among contacts. A simplified risk score including only five variables performed similarly, with only a small reduction in performance. INTERPRETATION This externally validated score will enable comprehensive biosocial, household-level interventions to be targeted to tuberculosis-affected households that are most likely to benefit. FUNDING Wellcome Trust, Medical Research Council, Department of Health and Social Care, Department for International Development, Joint Global Health Trials consortium, Bill & Melinda Gates Foundation, Innovation for Health and Development.

中文翻译：

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用于预测结核病患者接触者患结核病风险的家庭评分：一项推导和外部验证前瞻性队列研究。

背景 风险分层可能会改善受结核病影响的家庭的社会保护和生物医学干预措施的流行病学影响和成本效益。因此，我们得出并在外部验证了家庭风险评分，以预测结核病患者接触者中的结核病。方法 在这项前瞻性队列研究中，我们从秘鲁利马卡亚俄的 15 个沙漠棚户区和 17 个城市社区招募了受结核病影响的家庭。受结核病影响的家庭包括新诊断出结核病的指标患者及其报告在指标患者诊断前 2 周内每周与指标患者住在同一所房子超过 6 小时的接触者。如果指标患者没有符合条件的接触者或独居，则不包括受结核病影响的家庭。我们对接触者进行追踪直至 2018 年，并将家庭结核病（主要结果）定义为 3 年内患有任何形式结核病的任何接触者。我们使用逻辑回归来识别可预测家庭结核病的指标患者、接触者和家庭的特征，并使用这些特征来推导和外部验证家庭水平评分。调查结果 2007 年 12 月 12 日至 2015 年 12 月 31 日期间，来自文塔尼拉 3 301 个家庭的 16 505 名接触者被纳入派生队列。在 3 年随访期间，430 个家庭（13%，95% CI 12-14）的指标患者接触者中出现结核病。指数患者预测因素是肺结核和痰涂片分级、年龄、以及指示患者咳嗽时与他们接触的最大小时数。家庭预测因素包括吸毒、女户主的学业以及较低的食品支出。接触预测因素包括接触者中是否有儿童、体重较低（体重指数 [BMI] <20·0 kg/m2）成人接触者的数量、正常体重（BMI 20·0-24·9 kg）的数量/m2) 成人接触者，以及过去或现在患有结核病的家庭成员人数。在此推导队列中，得分 c 统计量为 0·77，得分最高的五分位数中家庭结核病的风险为 31%（95% CI 25-38；211 中的 65）对 2%（95% CI 0-4；211 中的 65）。 231 人中的 4 人）处于得分最低的五分位。我们从外部验证了 2014 年 4 月 23 日期间招募的来自卡亚俄 924 个家庭的 4248 名接触者的风险评分，2015 年 12 月 31 日。随访期间，120 个家庭（13%，95% CI 11-15）的指标患者接触者中出现结核病。该队列中的得分 c 统计量为 0·75，最高得分五分之一的家庭结核病风险为 28%（95% CI 21-36；154 人中的 43 人）与 1%（95% CI 0-5；其中两人） 148）处于得分最低的五分位。得分最高的三分之一家庭感染了接触者中约 70% 的结核病。仅包含五个变量的简化风险评分表现类似，仅性能略有下降。解释 这一经过外部验证的评分将使综合生物社会、家庭层面的干预措施能够针对最有可能受益的结核病影响家庭。资助 Wellcome Trust、医学研究委员会、健康和社会关怀部、