Comparative tuberculosis risk in healthcare and educational workers: occupational synergy

Background Healthcare workers (HCWs) face higher tuberculosis (TB) risk from occupational exposure. Whether their risk exceeds that of non-clinical institutional workers when matched on key factors is unclear. We compared HCWs with educational workers in South Korea while controlling for age, sex, and TB infection (TBI). Methods A retrospective cohort was conducted using national TBI screening data linked with the Korean National Health Insurance Service (NHIS) and TB Surveillance System. After 1:1 propensity score matching (PSM) on age, sex, and interferon-gamma release assay (IGRA), 203 959 HCWs and 203 959 educational workers were included. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for TB incidence for at least 2 years. Additive interaction between IGRA positivity and healthcare employment was assessed. Results TB incidence was highest in untreated IGRA-positive HCWs (245.5 per 100 000), while untreated IGRA-positive educational workers had a lower incidence of 77.0 per 100 000. Among IGRA-positive participants, untreated HCWs had a significantly higher risk of developing TB than untreated educational workers (aHR 2.18, 95% CI 1.56–3.06). Even IGRA-negative HCWs demonstrated elevated risk compared with IGRA-negative educational workers (aHR 1.76, 95% CI 1.10–2.83). Conclusion HCWs are at elevated risk of TB incidence, even after adjusting for infection status and demographics, most likely reflecting ongoing occupational exposure during follow-up. The simultaneous presence of two risk factors, employment in healthcare and IGRA positivity, substantially increased the incidence of TB. These findings highlight the need for targeted infection control, improved TBI treatment adherence, and early detection strategies in healthcare settings.