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. 2018 Nov;108(S4):S321-S326.
doi: 10.2105/AJPH.2018.304606.

Changes in Tuberculosis Disparities at a Time of Decreasing Tuberculosis Incidence in the United States, 1994-2016

Awal Khan  1 , Suzanne Marks  1 , Dolly Katz  1 , Sapna Bamrah Morris  1 , Lauren Lambert  1 , Elvin Magee  1 , Sloane Bowman  1 , Gail Grant  1
Affiliations

Changes in Tuberculosis Disparities at a Time of Decreasing Tuberculosis Incidence in the United States, 1994-2016

Awal Khan et al. Am J Public Health. 2018 Nov.

Abstract

Objectives: To assess national progress in reducing disparities in rates of tuberculosis (TB) disease, which disproportionately affects minorities.

Methods: We used Centers for Disease Control and Prevention (CDC) surveillance data and US Census data to calculate TB rates for 1994 through 2016 by race/ethnicity, national origin, and other TB risk factors. We assessed progress in reducing disparities with rate ratios (RRs) and indexes of disparity, defined as the average of the differences between subpopulation and all-population TB rates divided by the all-population rate.

Results: Although TB rates decreased for all subpopulations, RRs increased or stayed the same for all minorities compared with Whites. For racial/ethnic groups, indexes of disparity decreased from 1998 to 2008 (P < .001) but increased thereafter (P = .33). The index of disparity by national origin increased an average of 1.5% per year.

Conclusions: Although TB rates have decreased, disparities have persisted and even increased for some populations. To address the problem, the CDC's Division of TB Elimination has focused on screening and treating latent TB infection, which is concentrated among minorities and is the precursor for more than 85% of TB cases in the United States.

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Figures

FIGURE 1—
FIGURE 1—
Comparison of Tuberculosis Rates in US-Born and Non–US-Born Persons: United States, 1994–2016 Source. Adapted with inclusion of rate ratio from Centers for Disease Control and Prevention.
FIGURE 2—
FIGURE 2—
Trends in Rate Ratios for Tuberculosis Among Racial/Ethnic Minorities Compared With Whites: United States, 1994–2016 Note. AI/AN = American Indian/Alaska Native. Black: y = 7.957e0.001x; R2 = 0.0221. Hispanic: y = 5.5907e0.016x; R2 = 0.6911. AI/AN: y = 4.7031e0.0229x; R2 = 0.6339. Asian: y = 12.942e0.0372x; R2 = 0.9625.
FIGURE 3—
FIGURE 3—
Trend in Tuberculosis Rate Index of Disparity by Race/Ethnicity: United States, 1994–2016
FIGURE 4—
FIGURE 4—
Percentages of Tuberculosis Cases With Social or Medical Risks: United States, 2000–2016
See this image and copyright information in PMC

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