Trends in Tuberculosis, 2018
The declining TB rates in the United States are not enough to achieve TB elimination in this century.
Eliminating tuberculosis (TB) will require interrupting TB transmission as well as major efforts to address latent TB infection. In 2018, a total of 9,025 TB cases were reported in the United States. This represents a 0.7% decrease from 2017.
The national incidence rate was 2.8 cases per 100,000 persons (1.3% decrease from 2017).
The number of persons who died from TB decreased from 2016.
In 2017, the most recent data available, 515 deaths in the United States were attributed to TB. This is a decrease from 528 deaths attributed to TB in 2016.
TB disease in the United States is most common among people who were born in countries with high rates of TB.
In 2018, a total of 70.2% of reported TB cases in the United States occurred among non-U.S.-born people.
The percentage of TB cases that are drug resistant has remained stable for the last 20 years.
TB bacteria may become resistant to the drugs used to treat TB. This is called drug-resistant TB and means that the drug can no longer kill the bacteria. Drug-resistant TB poses a serious threat to our ability to treat and control TB.
- In 2018, the most common form of primary resistance was isoniazid (INH) resistance. INH resistance occurred in 605 cases (9.4% of cases with drug susceptibility results).
- Multidrug-resistant TB (MDR TB) is resistant to at least isoniazid (INH) and rifampin (RIF). There were 98 MDR TB cases (1.5% of cases with drug susceptibility results) in 2018.
- Extensively drug-resistant TB (XDR TB) is resistant to INH and RIF, any fluoroquinolone, and at least three of the injectable second-line anti-TB drugs. There was 1 case of XDR TB in the United States in 2018.
- The number of drug-resistant cases in 2018 decreased by 30 cases from 2017. However, the percentage of TB cases that are drug resistant has remained stable for the last 20 years.
Approximately half of all TB cases were reported from four states.
In 2018, among U.S. states, the majority of TB cases continued to be reported from 4 states: California (23.2%), Texas (12.5%), New York (8.3%), and Florida (6.5%).
Minority populations continue to be disproportionately affected by TB disease.
In 2018, despite a downward trend among non-Hispanic Asians and non-Hispanic blacks, the incidence rates remained high. Incidence rates remained essentially unchanged from 2017 among all other racial/ethnic groups.
Additional Risk Factors:
Of persons diagnosed with TB in 2018:
- 19.8% reported having diabetes
- 9.3% reported excessive alcohol use
- 5.1% were co-infected with HIV
- 6.8% reported using noninjectable drugs (1.3% reported using injecting drugs)
- 4.3% reported being homeless in the past year
- 3.6% were residents of correctional settings at time of diagnosis
Eliminating TB in the United States requires a dual approach.
TB elimination would have widespread health, economic, and social benefits for the United States. Ending TB will require maintaining and strengthening current TB control priorities while increasing efforts to identify and treat latent TB infection among high-risk populations.