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. 2019 Jul 1;23(7):797-804.
doi: 10.5588/ijtld.18.0757.

Changes in tuberculosis epidemiology, United States, 1993-2017

L R Armstrong  1 , C A Winston  1 , B Stewart  1 , C A Tsang  1 , A J Langer  1 , T R Navin  1
Affiliations

Changes in tuberculosis epidemiology, United States, 1993-2017

L R Armstrong et al. Int J Tuberc Lung Dis. .

Abstract

BACKGROUND: After 20 years of steady decline, the pace of decline of tuberculosis (TB) incidence in the United States has slowed.METHODS: Trends in TB incidence rates and case counts since 1993 were assessed using national US surveillance data. Patient characteristics reported during 2014-2017 were compared with those for 2010-2013.RESULTS: TB rates and case counts slowed to an annual decline of respectively 2.2% (95%CI -3.4 to -1.0) and 1.5% (95%CI -2.7 to -0.3) since 2012, with decreases among US-born persons and no change among non-US-born persons. Overall, persons with TB diagnosed during 2014-2017 were older, more likely to have combined pulmonary and extra-pulmonary disease than extra-pulmonary disease alone, more likely to be of non-White race, and less likely to have human immunodeficiency virus infection, or cavitary pulmonary disease. During 2014-2017, non-US-born persons with TB were more likely to have diabetes mellitus, while the US-born were more likely to have smear-positive TB and use non-injecting drugs.CONCLUSION: Changes in epidemiologic trends are likely to affect TB incidence in the coming decades. The Centers for Disease Control and Prevention has called for increased attention to TB prevention through the detection and treatment of latent tuberculous infection.

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Conflict of interest statement

Conflict of interests: non declared.

Figures

Figure 1a
Figure 1a
Trends in tuberculosis incidence, US National Tuberculosis Surveillance System, 1993–2017.
Figure 1b
Figure 1b
Tuberculosis case counts, US National Tuberculosis Surveillance System, 1993–2017
Figure 2a
Figure 2a
Incidence trends among non-US–born tuberculosis patients, US National Tuberculosis Surveillance System, 1993–2017.
Figure 2b
Figure 2b
Trends in case counts among non-US–born tuberculosis patients, US National Tuberculosis Surveillance System, 1993–2017.
Figure 3a
Figure 3a
Incidence trends among among US-born tuberculosis patients, US National Tuberculosis Surveillance System, 1993–2017.
Figure 3b
Figure 3b
Trends in case counts among among US-born tuberculosis patients, US National Tuberculosis Surveillance System, 1993–2017.
Figure 4
Figure 4
Tuberculosis case counts among non-US–born persons by time since arrival in the United States, US National Tuberculosis Surveillance System, 1993–2017.
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