Trends in Tuberculosis, 2021

Tuberculosis (TB) is preventable and treatable, but too many people still suffer from TB.  

Ending TB will require a dual approach of maintaining and strengthening current TB control priorities, while increasing efforts to identify and treat latent TB infectionespecially in populations at increased risk of TB disease. Healthcare providers, TB programs, and communities play an important role in ending TB in the United States.  

Progress toward TB elimination slowed in recent years and the COVID-19 pandemic strained public health services, including TB prevention and control services.

TB case counts and incidence rates have steadily decreased in the United States since 1992. In 2020, the annual rate of decline was substantially greater than in previous years, probably because of factors associated with the COVID-19 pandemic, including a combination of TB underdiagnosis and a true reduction in TB incidence.

In 2021, the United States reported 7,882 TB cases and an incidence rate of 2.4 cases per 100,000 persons (TB Incidence and Mortality: 1953–2021). TB data from 2021 reveal a rebound in the number of reported cases of TB disease in the United States. This might be explained by a lessening of the effects of factors associated with the COVID-19 pandemic and delayed detection of cases with symptom onset during 2020 that were not diagnosed until 2021 because of delayed healthcare access or missed diagnoses. However, TB incidence in 2021 remained 12.4% lower compared with 2019, which might be explained by longer lasting effects of the COVID-19 pandemic, including TB underdiagnosis and public health resource constraints.

As the effects of the COVID-19 pandemic shift over time, we must rededicate our efforts and resources to achieve TB elimination in the United States.

Anyone can get TB, but some people are at greater risk of TB than others.

TB disproportionately affects some groups depending on various demographic, health, and social factors.

In 2021, persons with TB disease in the United States identified as

  • Non-Hispanic Asian persons (36.0%)
  • Hispanic or Latino persons (30.6%)
  • Non-Hispanic Black or African American persons (18.0%)
  • Non-Hispanic White persons (11.2%)

Source: TB by Race/Ethnicity: 1993–2021

People who were born in countries where TB disease is more common are at substantially greater risk of exposure to TB.

  • Consistent with previous years, in 2021, the majority of reported TB cases occurred among non-U.S.–born persons (71.4%).

Source: TB by Origin of Birth: 1993–2021

Medical conditions that weaken the immune system, such as, diabetes mellitus and human immunodeficiency virus (HIV), can increase a person’s risk of developing TB disease if they are infected.

  • In 2021, diabetes mellitus (23.9%) was the most commonly reported medical risk factor for TB disease.

Source: TB Risk Factors, by Origin and Race/Ethnicity: 2021

  • Among persons with TB disease in 2021 who were alive at diagnosis, HIV status was known for 90.5%. Of those persons with TB disease and known HIV status, 4.2% had HIV.
    • Among persons with TB disease with known HIV status, HIV coinfection occurred for 6.3% of persons aged 25–44 years and 5.6% of persons aged 45–64 years.

Source: TB Among Persons with HIV Coinfection: 2011–2021

People living in congregate settings, including correctional facilities, detention centers, long-term care facilities, and homeless shelters, are at increased risk of becoming infected with TB due to shared airspaces.

  • In 2021, 2.4% of persons 15 years of age or older diagnosed with TB disease were current residents of correctional facilities at the time of diagnosis.

Source: TB in Correctional Facilities: Reporting Areas, 2021

  • During 2021, 1.5% of persons 15 years of age or older diagnosed with TB disease were current residents of long-term care facilities.

Source: TB Social Risk Factors: Reporting Areas, 2021

  • Among persons 15 years of age or older with TB disease in 2021, 341 (4.5%) reported experiencing homelessness within the 12 months preceding TB diagnosis compared with 290 (4.3%) in 2020.

Source: TB Social Risk Factors: Reporting Areas, 2021