Trends in Tuberculosis, 2020

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

During 2020, the United States reported the lowest number of TB cases (7,174) and lowest incidence rate (2.2 cases per 100,000 persons) on record (TB Incidence and Mortality (Vital Statistics): 1953–2020).

Except for 2015, the U.S. TB case count and incidence rate have declined every year since 1992, but the drop in 2020 was much steeper than previous years.

The 2020 data reveal a substantial decline in the number of reported cases of TB disease in the United States. The COVID-19 pandemic has probably affected reported TB incidence in the United States in several ways, including a combination of  TB underdiagnosis and a true reduction in incidence. CDC is conducting additional analyses to better understand how the 2020 TB disease data compare with previous years.

Despite the decline in TB cases and incidence rates in the United States, our current strategies are not enough to achieve TB disease elimination in this century.

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 2020, the majority of persons with TB disease in the United States identified as

  • Non-Hispanic Asian persons; 35.8%,
  • Hispanic persons; 29.7%,
  • Non-Hispanic Black persons; 19.6%, or
  • Non-Hispanic White persons; 11.0%.

Source: TB by Race/Ethnicity: 1993–2020

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, the majority of reported TB cases occurred among non-U.S.–born persons (71.5%).

Source: TB by Origin of Birth: 1993–2020

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 2020, diabetes mellitus (22.5%) was the most commonly reported medical risk factor for TB disease.

Source: TB Risk Factors, by Origin and Race/Ethnicity: 2020

  • Among persons with TB disease in 2020 who were alive at diagnosis, HIV status was known for 89.8%. Of those persons with TB disease and known HIV status, 4.8% had HIV.
    • Among persons with TB disease with known HIV status, HIV coinfection occurred for 8.0% of persons aged 25–44 years and 5.9% of persons aged 45–64 years.

Source: TB Among Persons with HIV Coinfection: 2011–2020

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 2020, 2.6% 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, Ages ≥15 Years: Reporting Areas, 2020

  • During 2020, 1.7% of persons 15 years of age or older diagnosed with TB disease were current residents of long-term care facilities.

Source: TB in Long-Term Care Facilities, Ages ≥15 Years: Reporting Areas, 2020

  • Among persons 15 years of age or older with TB disease in 2020, 290 (4.3%) reported experiencing homelessness within the 12 months prior to TB diagnosis compared with 383 (4.6%) in 2019.

Source: TB in Persons Experiencing Homelessness, Ages ≥15 Years: Reporting Areas, 2020