Epidemiology of Tuberculosis in African-American Population, United States 1993-2005

1
Epidemiology of Tuberculosis in African-American
Population,United States 1993-2005
Stop TB in the African-American Community May
16-17, 2006 Atlanta, Georgia

• Kenneth G. Castro, M.D.
• Assistant Surgeon General, USPHS
• Director, Division of Tuberculosis Elimination
• National Center for HIV, Hepatitis, STD, and TB
  Prevention
• Coordinating Center for Infectious Diseases

Proposed
2
Reported TB Cases United States, 19822005
14,093
No. of Cases
Year
3
Reported TB Cases by Race/Ethnicity, United
States, 2005
American Indian or Alaska Native (1)
White (18)
Asian (23)
Native Hawaiian or Other Pacific Islander (lt1)
Hispanic or Latino (29)
Black or African American (28)
All races are non-Hispanic. Persons reporting
two or more races accounted for less than 1 of
all cases and are not shown. 2005 data
provisional
4
Reported TB Cases in U.S.-born and Foreign-born,
by Race/Ethnicity. U.S. 19932004
U.S.-born U.S.-born Foreign-born Foreign-born
Total N N
White, Non-Hispanic 47534 89 6111 11
Black, Non-Hispanic 61379 85 10924 15
Hispanic 16613 32 34655 68
American Indian/ Alaska Native 2881 98 63 2
Asian/Pacific Islander 2561 6 40862 94
5
Reported TB Cases in U.S.-born, by
Race/Ethnicity, U.S., 19932004
N
White, Non-Hispanic 47534 36
Black, Non-Hispanic 61379 47
Hispanic 16613 13
American Indian/ Alaska Native 2881 2
Asian/Pacific Islander 2561 2
6
Characteristics Among Selected U.S.-born Persons
with TB, 2004
Black
White
No. cases 2,675 2,209
Male 70 67
Median age (years) 46 57
Non-Hispanic
7
TB Rates in U.S.-born, by Race/Ethnicity,United
States, 19932004
TB Cases /100,000 (log scale)
Black, non-Hispanic
8
TB Cases in U.S.-born African Americans, United
States, 20002004
D.C.
lt 99
100399
gt 400
9
Percent of TB Cases in Persons with History of
Substance Abuse, 19932004
Percent
Injecting drug, non-injecting drug, or excess
alcohol use in year prior to TB
diagnosis U.S.-born non-Hispanic
10
Estimated HIV Coinfection in Persons Reported
with TB, 19932004
Coinfection
U.S.-born non-Hispanic Note Minimum estimates
based on reported HIV-positive status among all
TB cases in the race group.
11
Percent of Persons with TB Diagnosed in a
Correctional Facility, 1993-2004
U.S.-born non-Hispanic
12
Percent of TB Cases in Homeless Persons (Year
Prior to Diagnosis), 1993-2004
U.S.-born non-Hispanic
13
Percent of TB Cases in Unemployed Persons (in 2
Years Prior to Diagnosis), 1994-2004
U.S.-born non-Hispanic
14
Percent of U.S.-born Persons with TB, by
Race/Ethnicity and Health Provider Type, 2004
Provider Type
Health department 59 50
Private/other 17 21
Both 23 27
Black
White
For all outpatient care U.S.-born non-Hispanic
15
Reported TB Cases, by Completion of Therapy,
U.S.,19932002
Overall Completion Rate () Completed within 1 year ()
White, Non-Hispanic 86 76
Black, Non-Hispanic 85 72
Hispanic 81 73
American Indian/ Alaska Native 88 79
Asian/Pacific Islander 83 76
16
Completion of TB Therapy in 1-Year United
States, 19932002
Percent
U.S.-born non-Hispanic Excludes persons with
initial isolate resistant to rifampin and
children under 15 years old with meningeal, bone
or joint, or miliary disease.
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Summary

• TB rates steadily declined between 1993-2004 in
  all race/ethnic groups African-Americans are
  largest U.S.-born group (47)
• TB rates among African-Americans consistently gt8
  times higher than whites throughout 1993-2004.
  Closing the race/ethnic gap crucial to
  elimination
• Geographic concentration of TB in
  African-Americans in Southeast and Northeast
• TB in African-Americans associated with HIV,
  substance abuse, incarceration
• Completion of therapy similar and improving in
  both groups

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"Insanity is doing the same thing over and over
again and expecting different results."

• - Albert Einstein

19
the issue now confronting the nation is whether
we will allow another cycle of neglect to begin
or, instead, whether we will take decisive action
to eliminate tuberculosis.
20
Characteristics of Selected U.S.-born Persons
with TB, 2004
Black
White
Characteristic No. () No. ()
MDR TB 12 (0.5) 10 (0.5)
HIV-positive 488 (16) 89 (4)
Substance abuse 1001 (34) 609 (27)
U.S.-born non-Hispanic MDR TB defined as
resistance to at least isoniazid and
rifampin. HIV data for year 2004 may not be
complete Substance abuse defined as injecting
drug, non-injecting drug, or excess alcohol use
in year prior to TB diagnosis.