Epidemiology of Tuberculosis in

African-American Population,United States 1993-2005

Kenneth G. Castro, M.D.Assistant Surgeon General, USPHS

Director, Division of Tuberculosis EliminationNational Center for HIV, Hepatitis, STD, and TB Prevention*

Coordinating Center for Infectious Diseases

Stop TB in the African-American CommunityMay 16-17, 2006Atlanta, Georgia

*Proposed

*Data for 2005 are provisional.

Reported TB Cases United States, 1982–2005*

10,00012,00014,00016,00018,00020,00022,00024,00026,00028,000

1983 1987 1991 1995 1999 2005

Year

No

. of

Ca

ses 14,093

Reported TB Cases by Race/Ethnicity, United States, 2005*

Hispanic or Latino(29%) Black or African American

(28%)

Asian(23%)

White(18%)

American Indian or Alaska Native (1%)

Native Hawaiian orOther Pacific Islander (<1%)

*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

Reported TB Cases in U.S.-born and Foreign-born, by Race/Ethnicity. U.S.

1993–2004 U.S.-born Foreign-born

TotalN % N %

White, Non-Hispanic 47534 89 6111 11Black, Non-Hispanic 61379 85 10924 15Hispanic 16613 32 34655 68American Indian/ Alaska Native

2881 98 63 2

Asian/Pacific Islander 2561 6 40862 94

Reported TB Cases in U.S.-born, by Race/Ethnicity, U.S., 1993–2004

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

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

1

10

100

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

TB Rates in U.S.-born, by Race/Ethnicity,United States, 1993–2004

TB

Ca

ses

/10

0,00

0(l

og

sc

ale

)

Black, non-Hispanic White, non-Hispanic

< 99

100–399

> 400

D.C.

TB Cases in U.S.-born African Americans, United States, 2000–2004

Percent of TB Cases in Persons with History of Substance Abuse,* 1993–2004

01020304050607080

Black** White**

Per

cen

t

*Injecting drug, non-injecting drug, or excess alcohol use in year prior to TB diagnosis**U.S.-born non-Hispanic

Estimated HIV Coinfection in Persons Reported with TB, 1993–2004

0

10

20

30

Black* White*

% C

oin

fect

ion

*U.S.-born non-HispanicNote: Minimum estimates based on reported HIV-positive status among all TB cases in the race group.

Percent of Persons with TB Diagnosed in a Correctional Facility, 1993-2004

02468

10

Per

cen

t

Black* White*

* U.S.-born non-Hispanic

Percent of TB Cases in Homeless Persons (Year Prior to Diagnosis), 1993-2004

0

5

10

15

Per

cen

t

Black* White** U.S.-born non-Hispanic

Percent of TB Cases in Unemployed Persons (in 2 Years Prior to Diagnosis), 1994-2004

0

20

40

60

80

Per

cen

t

Black* White*

* U.S.-born non-Hispanic

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

Reported TB Cases, by Completion of Therapy, U.S.,1993–2002

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

Completion of TB Therapy in 1-Year

United States, 1993–2002

0

20

40

60

80

100

Black* White*

*U.S.-born non-HispanicExcludes persons with initial isolate resistant to rifampin and children under 15 years old with meningeal, bone or joint, or miliary disease.

Per

cen

t

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 >8 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

"Insanity is doing the same thing over and over again and expecting

different results."

─ Albert Einstein

“…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.”

Characteristics of Selected U.S.-born Persons with TB, 2004

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 completeSubstance abuse defined as injecting drug, non-injecting drug, or excess alcohol use in year prior to TB diagnosis.

Black* White*