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In two cross-sectional studies of people deprived of liberty (PDL) in Medellin, we evaluated the impact of adjustment versus failure to adjust by clustering on prevalence ratio (PR) and 95% confidence interval (CI). We used log-binomial regression, Poisson regression, generalized estimating equations (GEE), and mixed-effects regression models. We used cluster-robust standard errors and bias-corrected standard errors. The odds ratio (OR) was 20% higher than the PR when the TB prevalence was &gt;10% in at least one of the exposure factors. When there are three levels of clusters (city, prison, and courtyard), the cluster that had the strongest effect was the courtyard, and the 95% CI estimated with GEE and mixed-effect models were narrower than those estimated with Poisson and binomial models. Exposure factors lost their significance when we used bias-corrected standard errors due to the smaller number of clusters. Tuberculosis transmission dynamics in prisons dictate a strong cluster effect that needs to be considered and adjusted for. The omission of cluster structure and bias-corrected by the small number of clusters can lead to wrong inferences.<\/jats:p>","DOI":"10.3390\/ijerph20075423","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T08:41:52Z","timestamp":1680770512000},"page":"5423","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tuberculosis in Prisons: Importance of Considering the Clustering in the Analysis of Cross-Sectional Studies"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4715-8388","authenticated-orcid":false,"given":"Diana","family":"Mar\u00edn","sequence":"first","affiliation":[{"name":"Facultad de Medicina, Universidad Pontificia Bolivariana, Medell\u00edn 050034, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoav","family":"Keynan","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada"},{"name":"Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada"},{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3111-0689","authenticated-orcid":false,"given":"Shrikant I.","family":"Bangdiwala","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada"},{"name":"Population Health Research Institute, McMaster University, Hamilton, ON L8L 2X2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucelly","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad Pontificia Bolivariana, Medell\u00edn 050034, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6342-1812","authenticated-orcid":false,"given":"Zulma Vanessa","family":"Rueda","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad Pontificia Bolivariana, Medell\u00edn 050034, Colombia"},{"name":"Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1016\/S0140-6736(20)32578-2","article-title":"The Escalating Tuberculosis Crisis in Central and South American Prisons","volume":"397","author":"Walter","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e300","DOI":"10.1016\/S2468-2667(21)00025-6","article-title":"Incidence and Prevalence of Tuberculosis in Incarcerated Populations: A Systematic Review and Meta-Analysis","volume":"6","author":"Cords","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e005639","DOI":"10.1136\/bmjgh-2021-005639","article-title":"Increasing Tuberculosis Burden in Latin America: An Alarming Trend for Global Control Efforts","volume":"6","author":"Ranzani","year":"2021","journal-title":"BMJ Glob. 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