Stop TB in the African-American Community

May 16-17, 2006

Atlanta, Georgia

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

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
 Reported TB Cases
United States, 1982–2005*
28,000
26,000
No. of Cases

24,000 14,093
22,000
20,000
18,000
16,000
14,000
12,000
10,000
1983 1987 1991 1995 1999 2005

Year

*Data for 2005 are provisional.

 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 (<1%)

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
Reported TB Cases in U.S.-born and
Foreign-born, by Race/Ethnicity. U.S.
1993–2004
U.S.-born Foreign-born
N % N %
Total

White, Non-Hispanic 47534 89 6111 11

Black, Non-Hispanic 61379 85 10924 15
Hispanic 16613 32 34655 68
American Indian/ Alaska 2881 98 63 2
Native
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 2881 2
Native

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 46 57
(years)

*Non-Hispanic
TB Rates in U.S.-born, by Race/Ethnicity,
United States, 1993–2004
100

10

1
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Black, non-Hispanic White, non-Hispanic

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

D.C.

< 99
100–399
> 400
 Percent of TB Cases in Persons with
History of Substance Abuse,* 1993–2004
80
70
Percent

60
50
40
30
20
10
0

93 94 95 96 97 98 99 00 01 02 03 04
19 19 19 19 19 19 19 20 20 20 20 20
Black** White**
*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
30
% Coinfection

20

10

93 94 95 96 97 98 99 00 01 02 03 04
19 19 19 19 19 19 19 20 20 20 20 20
Black* White*
*U.S.-born non-Hispanic
Note: 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
10
8
Percent

6
4
2
0
93

94

95

96

97

98

99

00

01

02

03

04
19

19

19

19

19

19

19

20

20

20

20

20
Black* White*
* U.S.-born non-Hispanic
Percent of TB Cases in Homeless Persons
(Year Prior to Diagnosis), 1993-2004

15
Percent

10
5
0

93 94 95 96 97 98 99 00 01 02 03 04
19 19 19 19 19 19 19 20 20 20 20 20

Black* White*
* U.S.-born non-Hispanic
Percent of TB Cases in Unemployed Persons
(in 2 Years Prior to Diagnosis), 1994-2004
80
60
Percent

40
20
0
94

95

96

97

98

99

00

01

02

03

04
19

19

19

19

19

19

20

20

20

20

20
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* Black** White**
Health department 59 50
Private/other 17 21
Both 23 27

*For all outpatient care

**U.S.-born non-Hispanic
Reported TB Cases, by Completion of
Therapy, U.S.,1993–2002
Overall Completed
Completion within 1 year
Rate (%) (%)
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
100
80
60
40
20
0

93 94 95 96 97 98 99 00 01 02
1 9 1 9 1 9 1 9 1 9 1 9 1 9 2 0 2 0 2 0

Black* White*
*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.
 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
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.