The United States (US) Centers for Disease Control and Prevention (CDC) has recently released preliminary data on tuberculosis incidence in the US in 2022. The report is published in the Morbidity and Mortality Weekly Report.
Morbidity and Mortality Weekly Report (MMWR) Tuberculosis — United States, 2022. Image Credit: Kateryna Kon / Shutterstock
Background
A gradual reduction in the reported incidence of tuberculosis has been observed in the United States between 1993 and 2019. In 2019, the incidence rate was 2.7 cases per 100,000 persons, which was further reduced to 2.2 cases per 100,000 persons during the coronavirus disease 2019 (COVID-19) pandemic starting in 2020.
Such reduction in tuberculosis incidence could be attributed to certain factors, including delayed or lack of diagnosis, travel- and migration-related restrictions, and death among persons susceptible to tuberculosis reactivation.
Tuberculosis incidence in the US
During 2021 and 2022, the incidence rates were 2.4 and 2.5 cases per 100,000 persons, significantly lower than that documented during pre-pandemic years. During 2022, 8,300 tuberculosis cases were reported to the National Tuberculosis Surveillance System, with California reporting the highest number of cases and Alaska reporting the highest incidence.
A variation in tuberculosis epidemiology was observed between 2021 and 2022. In 2022, the incidence was higher among non-US-born persons newly arrived in the United States. Specifically, a higher tuberculosis incidence was observed among non-Hispanic American Indian or Alaska Native and non-Hispanic Native Hawaiian or other Pacific Islander (NH/OPI) persons.
A similar trend was also observed among children aged four years and younger and adolescents and young adults aged 15 – 24. In contrast, a slightly lower incidence was observed among persons aged 65 years and above.
Among US-born persons with tuberculosis, the highest incidence in 2022 was observed among non-Hispanic Native Hawaiian or Other Pacific Islander persons (6.6 cases per 100,000), followed by American Indian or Alaska Native persons (4.4), Asian persons (2.2), and Black persons (1.9).
Tuberculosis disease cases and incidence, by patient U.S. birth origin status - National Tuberculosis Surveillance System, United States, 2012–2022
Compared to 2021, the 2022 incidence increased by 63% among Asian persons, 26% among non-Hispanic Native Hawaiian or Other Pacific Islander persons, 16% among American Indian or Alaska Native persons, and 7% among Hispanic persons. In contrast, the incidence was reduced by 9% and 10% among Black and White persons, respectively.
Among non-US born persons with tuberculosis, the incidence was highest among non-Hispanic Native Hawaiian or Other Pacific Islander persons (27.8), followed by Asian persons (22.0), Black persons (13.7), Hispanic persons (10.1), American Indian or Alaska Native persons (4.3), and White persons (3.4).
Compared to 2021, the 2022 incidence increased by 221% among American Indian or Alaska Native persons, 20% among non-Hispanic Native Hawaiian or Other Pacific Islander persons, 13% among Hispanic persons, and 7% among White persons. In contrast, the incidence was reduced by 12% among Black persons and 7% among Asian persons.
Regarding tuberculosis detection in 2022, about 16.5% of non-US-born persons received a diagnosis less than one year after their first arrival in the United States. In 2021, the percentage was 9.8. In 2021 and 2022, the percentages of people with newly diagnosed tuberculosis living in the US for more than ten years were 50.2 and 46.9, respectively.
Considering different age groups, the highest increase in tuberculosis incidence was observed among children aged four years and younger (28.8%) and adolescents and young adults aged 15 – 24 (23.7%) in 2022. An increase in incidence was also observed among homeless people (4.8%) and those living in prisons (3.5%). In contrast, a reduction in incidence was only observed among older adults aged 65 years and above (1.8%).
Conclusion
Phillip LoBue, MD, director of CDC's Division of Tuberculosis Elimination, said in a press release, "the message is loud and clear tuberculosis is still here. Communities, providers, and public health partners must work together to make sure we are reaching the right people with testing and treatment, so we can prevent and stop the spread of tuberculosis."
New classification of tuberculosis aims to improve focus on the early stages of disease