TB Rates Dropping, But Disparity Persists

While the rate of tuberculosis (TB) is on the decline in the United States, a large disparity still exists between the number of U.S.-born and foreign-born U.S. residents with TB.

From 2012 to 2013, the tuberculosis rate dropped among both groups, but only by 2.1% among foreign-born individuals, in comparison to an 8.4% decline among those born in the United States, according to a recent report from the Centers for Disease Control and Prevention (CDC). The report also found that racial and ethnic disparities are still an issue, with Asians experiencing a TB rate 25.9 times higher than that of whites, while African-Americans show a rate 6.2 times higher than whites.
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Overall, the incidence of tuberculosis among foreign-born persons was 15.6 cases per 100,000 population in 2013, which was 13 times higher than the rate of 1.2 per 100,000 in U.S.-born persons, according to the CDC, which defines a U.S.-born individual as anyone born in the United States or a foreign country, but having at least 1 parent who is a U.S. citizen.

On the heels of its report, the CDC also issued a statement noting that updated recommendations for overseas TB screening of immigrants and refugees have saved the United States an estimated $15 million. Since 2007, those suspected of having tuberculosis have been obligated to undergo a sputum culture instead of a less sensitive microscopic sputum smear test, so their infection could be caught and treated prior to arriving in the United States, according to the CDC.

The goal of eliminating tuberculosis is “closer than ever before, but significant challenges remain,” says Negar Niki Alami, MD, epidemic intelligence officer at CDC, and lead author of the report.

While new national data show TB continues to fall to an all-time low in the United States—less than 10,000 cases in 2013—the disease “continues to take a heavy toll on many communities,” says Alami.

Foreign-born individuals are particularly affected, with a rate 13 times higher than that of those born in the United States, notes Alami, adding that foreign-born residents now account for 65% of total cases.

“Addressing TB among foreign-born individuals will take work on multiple fronts,” according to Alami. “The CDC is working with officials in other countries to improve TB control efforts in high-incidence areas, and has issued recommendations for improved screening and treatment of immigrants and refugees prior to U.S. entry. We are also testing arrivals from high-incidence countries for latent TB infection, and strengthening notification systems for local health departments when immigrants arrive.”

For primary care practitioners, it is critical to “recognize that TB is not a disease of the past, and remains a serious public health concern,” continues Alami.

“Practitioners should always be alert for symptoms associated with TB … and diagnose any suspected cases quickly and accurately. Taking a thorough medical history, including consideration of demographic factors and risk factors that may increase the patient’s risk for exposure to TB or drug-resistant TB, is also key. For TB disease, directly observed therapy is an important part of ensuring the patient is taking their medication and determining that the medication is properly treating the disease.”

—Mark McGraw

Reference

Alami N, Yuen C, et al. Trends in Tuberculosis—United States, 2013. Morbidity and Mortality Weekly Report. 2014.