Tuberculosis Among Native Hawaiian and Other Pacific Islander Persons: United States and U.S.-Affiliated Pacific Islands, 2010-2019

Abstract

Background: In recent years, tuberculosis (TB) incidence in the United States has declined overall but remained high among Native Hawaiian and Other Pacific Islander (NH/PI) persons. Few studies have examined the epidemiology of TB among NH/PI persons, particularly in the U.S.-Affiliated Pacific Islands (USAPI). We describe TB incidence and characteristics of NH/PI patients during 2010-2019.

Methods: We used data from the National Tuberculosis Surveillance System to characterize TB cases reported among NH/PI persons born in the 50 U.S. states (defined to include District of Columbia) and the USAPI. We calculated annual TB incidence among NH/PI patients, stratified by place of birth (U.S. states or USAPI). Using Asian persons born outside the United States-persons historically grouped with NH/PI persons as one racial category-as the reference, we compared demographic, clinical, and socio-behavioral characteristics of NH/PI TB patients.

Results: During 2010-2019, 4359 TB cases were reported among NH/PI patients born in the U.S. states (n=205) or the USAPI (n=4154). Median annual incidence per 100,000 persons was 6.5 cases (persons born in the U.S. states) and 150.7 cases (persons born in the USAPI). The proportion of TB patients aged <15 years was higher among NH/PI persons (U.S. states: 54%, USAPI: 24%) than among Asian persons born outside the United States (1%).

Conclusions: TB incidence among NH/PI persons is high, particularly among persons born in the USAPI, emphasizing the need to enhance TB prevention strategies in these communities. Interventions should be tailored toward those who experience the highest risk, including NH/PI children and adolescents.

Keywords: U.S.-Affiliated Pacific Islands; tuberculosis.

FIG. 1.

Annual incidence of TB disease (cases per 100,000 persons) among non-Hispanic, single-race NH/PI, Asian and White persons by place of birth, 2010–2019. Incidence calculated as quotient of (1) number of NH/PI TB patients born in the U.S. states and estimated number of NH/PI persons born in the U.S states, (2) number of NH/PI TB patients born in the USAPI and estimated number of NH/PI persons born in the USAPI, (3) number of White TB patients born in the U.S. states and estimated number of White persons born in the U.S states, and (4) number of Asian TB patients born in Asia and estimated number of Asian persons born in Asia. See Supplementary Text for additional details regarding population denominator estimates. Note: multiple mass screening events to identify cases of active TB were conducted in the Republic of the Marshall Islands starting in 2017. NH/PI, Native Hawaiian and Pacific Islander; TB, tuberculosis; USAPI, U.S.-Affiliated Pacific Islands.

FIG. 2.

Crude annual TB incidence (per 100,000 persons) among NH/PI persons with TB disease reporting being born in the USAPI by region, 2010–2019. Incidence proportions calculated for each region/year as the quotient of the number of TB cases reported among NH/PI persons reporting being born in any of the six USAPI regions and estimated number of NH/PI persons reporting being born in each region (see Supplementary Text for additional details regarding population estimates). Note: multiple mass screening events to identify cases of active TB were conducted in the Republic of the Marshall Islands starting in 2017.

FIG. 3.

Crude annual TB incidence (per 100,000 persons) among NH/PI persons with TB disease reporting being born in the 50 States among the four Department of Health and Human Service regions with highest median incidence, 2010–2019. Incidence proportions calculated for each region/year as the quotient of the number of TB cases reported among NH/PI persons reporting being born in the 50 states and estimated number of NH/PI persons reporting being born in each HHS region. See Supplemental Text for information regarding population estimates. Note: the small numerators (<5) for many of these calculations yield highly variable incidence estimates that are not statistically reliable. HHS, U.S. Department of Health and Human Services.

FIG. 4.

PRs comparing frequency of selected characteristics among NH/PI TB patients (50 states and USAPI) with Asian patients. PRs calculated as the proportion of NH/PI TB patients aged ≥15 years, stratified by place of birth, reporting each characteristic divided by the proportion of Asian TB patients aged ≥15 years reporting each characteristic. See Supplementary Table 1 for additional details. For TB cases reported to NTSS during 2010–2019, patients with unknown or missing information for a characteristic were excluded from PR calculations for that characteristic. The dashed line represents a null value of PR=1. ^aIncludes both injection and non-injection drug use. ^bSmear, sputum smear; restricted patients with pulmonary disease and patients with available information. NTSS, National Tuberculosis Surveillance System; PR, prevalence ratio.