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Trends in Tuberculosis, 2016

 

Key Findings

Reported TB Cases in the United States, 1982-2016

The rate of decline in the United States remains too slow 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 2016, a total of 9,272 TB cases were reported in the United States. This represents a 2.9% decrease from 2015.

The national incidence rate was 2.9 cases per 100,000 persons (3.6% decrease from 2015).

TB Cases Rates, United States, 2016 TB was reported in all 50 states

Nine states, the District of Columbia (DC), and New York City reported incidence rates above the national average.

TB case counts were highest in California, Texas, New York (including New York City), and Florida. These four states accounted for just over half of the total cases in the United States.

CDC Recent TB Transmissions IconCDC estimated recent transmission of TB

CDC estimated that about 14% of U.S. TB cases with genotype data are attributed to recent transmission. Distinguishing the numbers of cases attributed to recent transmission from those likely due to reactivation of longstanding, untreated latent TB infection is one of many tools state and local TB programs can use to design and prioritize effective public health interventions. These estimates can be used by state and local TB programs to track progress in the control of recent transmission.

Icon - The percentage of TB cases that are drug resistant has remained stable for the last 20 years.  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 2016, the most common form of primary resistance was isoniazid (INH) monoresistance or INH only resistance. INH only resistance occurred in 577 cases (8.7% of cases with drug susceptibility results).
  • Multidrug-resistant TB (MDR TB) is resistant to both isoniazid (INH) and rifampin (RIF). There were 96 MDR TB cases (1.4% of cases with drug susceptibility results) in 2016.
  • 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 2016.

icon - the number of persons who died of TB decreased.The number of persons who died of TB decreased.

In 2015, the most recent data available, 470 deaths were attributed to TB.

Icon - Incidence rates decreased for all racial and ethnic groups.Incidence rates decreased for all racial and ethnic groups.

Minority populations continue to disproportionately bear the burden of TB disease. The incidence rates for racial/ethnic groups in 2016 were:

  • American Indians or Alaska Natives: 4.7 TB cases per 100,000 persons
  • Asians: 18.0 TB cases per 100,000 persons
  • Blacks or African Americans: 4.9 TB cases per 100,000 persons
  • Native Hawaiians and other Pacific Islanders: 13.9 TB cases per 100,000 persons
  • Hispanics or Latinos: 4.5 TB cases per 100,000 persons
  • Whites: 0.6 TB cases per 100,000 persons

Note: for this report, persons identified as white, black, Asian, American Indian/Alaska Native, native Hawaiian or other Pacific Islander, or of multiple races are all non-Hispanic. Persons identified as Hispanic may be of any race.

Risk Factors for TB in the United States

Icon - U.S. born and non-U.S.–born personsU.S. born and non-U.S.–born persons

TB disease in the United States is most common among people who travel to or who were born in countries with high rates of TB.

  • In 2016, a total of 68.5% of reported TB cases in the United States occurred among non-U.S.–born persons.
  • Asians: 18.0 TB cases per 100,000 persons
  • The case rate among non-U.S.–born persons (14.7 cases per 100,000 persons) was approximately 14 times higher than among U.S.-born persons (1.1 cases per 100,000 persons).
  • The percentage of U.S. TB cases among non-U.S.–born persons who have been in the United States for 10 years or longer are about equal to those who have been in the United States less than 10 years.

Icon - Additional Risk Factors for TB diseaseAdditional Risk Factors for TB disease

Of persons diagnosed with TB in 2016:

  • 16.4% reported having diabetes
  • 10.0% reported excessive alcohol use
  • 5.6% were co-infected with HIV (of TB cases with HIV test results reported)
  • 6.8% reported using non-injectable drugs (1.3% reported using injecting drugs)
  • 4.9% reported being homeless in the past year
  • 4.0% were residents of correctional settings at time of diagnosis

Icon - Completion of TB TreatmentCompletion of TB Treatment

Prompt and effective treatment of TB disease is critical to prevent ongoing transmission of TB. In 2014, the most recent year for which completion data are available, of TB patients who could be appropriately treated within 1 year of diagnosis, 90.1% completed treatment.
The majority of TB patients (63.9%) received treatment by directly observed therapy (DOT) only, and 29% of patients received a combination of DOT and self-administered therapy. These numbers have remained stable since 2011.

Eliminating TB in the United States

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.

Surveillance Data

The most recent surveillance report, Reported Tuberculosis in the United States, 2016, includes data from 60 reporting areas (the 50 states, the District of Columbia, New York City, Puerto Rico, and seven other U.S. jurisdictions in the Pacific and Caribbean).

If you need additional state-specific data not available in this report, contact your state TB control office.

Additional Resources:

  • AtlasPlus: an interactive tool that allows users to observe trends and patterns by creating detailed reports, maps, and other graphics showing geographic patterns and time trends.
  • Online Tuberculosis Information System (OTIS): an interactive data system containing information on TB cases reported to CDC in 1993-2015. Users can select criteria to produce specific reports. Data are available by year, state, and demographic factors.

References

CDC. CDC. Reported Tuberculosis in the United States, 2016. Atlanta, GA: U.S. Department of Health and Human Services, CDC, November 2017. Available at http://www.cdc.gov/tb/statistics/reports/2016

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