Black or African American Persons

Since 1993, the rates of TB in the United States have declined in almost all racial and ethnic groups. Rates of TB in non-Hispanic Black or African American persons have been cut nearly in half (from 7.6 cases per 100,000 persons in 2009 compared to 4.3 in 2019) over the past decade.

However, Black or African American persons in the United States continue to be impacted by TB at a greater rate compared to other racial and ethnic minority groups.

Addressing the TB disparity among Black or African American persons is an important priority; prevention and control efforts should be targeted to this population.

The Numbers

In 2019, U.S. state, local, and territorial health agencies reported 8,916 TB cases to CDC.

  • In 2019, TB disease was reported in 1,753 non-Hispanic Black or African American persons in the United States, accounting for nearly 20% of all people reported with TB nationally.
  • The rate of TB disease is 8 times higher for non-Hispanic Black or African American persons than for non-Hispanic White persons.
  • Read more of the 2019 surveillance data in Reported Tuberculosis in the United States, 2019.

Prevention Challenges

TB is a challenging disease to diagnose, treat, and control. Dwindling resources and loss of public health capacity, including access to care and maintaining clinical and public health expertise, add to the challenge. It is critical to reach those populations at highest risk for TB, and to identify and implement innovative strategies to improve diagnosis and treatment.

Ending TB will require a dual approach of maintaining and strengthening current TB control priorities, while increasing efforts to identify and treat latent TB infection in populations at risk for TB disease.

Similar to other racial and ethnic minority groups, Black or African American persons face a number of challenges that contribute to higher rates of TB. Challenges include:

  • Treatment Duration and Completion
    • Treatment for TB disease can be lengthy. Patients are often unable or reluctant to take medication for several months. For people with TB disease, inadequate treatment can lead to treatment failure, relapse, ongoing transmission, and development of drug resistance.
    • For people with latent TB infection, treatment for a condition with no symptoms of illness may not be a priority.
  • Socioeconomic Factors
    • People experiencing poverty, including those with limited access to quality health care, unemployment, housing, and transportation, disproportionately experience adverse health outcomes. These factors can directly or indirectly increase the risk for TB disease and present barriers to treatment.
    • Language and cultural barriers, including health knowledge, stigma associated with the disease, values, and beliefs may also place certain populations at higher risk. Stigma may deter people from seeking medical care or follow up care.
  • HIV and Other Medical Conditions
    • TB remains a serious threat, especially for people who are infected with human immunodeficiency virus (HIV). People infected with HIV are more likely than uninfected people to get sick with other infections and diseases, including TB.
      • Without treatment, as with other opportunistic infections, HIV and TB can work together to shorten the life of the person infected.
    • In addition to HIV, other underlying medical conditions may increase the risk that latent TB infection will progress to TB disease. For example, the risk is higher in people with diabetes, substance abuse (including injection of illegal drugs), silicosis, or those undergoing medical treatments with corticosteroids.

Additional References

Marks SM, Katz DJ, Davidow AL, Pagaoa MA, Teeter LD, Graviss EA. The Impact of HIV Infection on TB Disparities Among US-Born Black and White Tuberculosis Patients in the United Statesexternal iconexternal icon. J Public Health Manag Pract. 2019.

Khan A, Marks S, Katz D, Morris SB, Lambert L, Magee E, Bowman S, Grant G. Changes in Tuberculosis Disparities at a Time of Decreasing Tuberculosis Incidence in the United States, 1994-2016external iconexternal icon. Am J Public Health. 2018;108(S4):S321-S326.

Royce RA, Colson PW, Woodsong C, Swinson-Evans T, Walton W, Maiuri A, DeLuca N; Tuberculosis Epidemiologic Studies Consortium (TBESC). Tuberculosis Knowledge, Awareness, and Stigma Among African-Americans in Three Southeastern Counties in the USA: a Qualitative Study of Community Perspectivesexternal iconexternal icon. J Racial Ethn Health Disparities. 2017;4(1):47-58.

Howley MM, Rouse CD, Katz DJ, Colson PW, Hirsch-Moverman Y, Royce RA; Tuberculosis Epidemiologic Studies Consortium. Knowledge and Attitudes About Tuberculosis Among U.S.-Born Blacks and Whites with Tuberculosisexternal iconexternal icon. J Immigr Minor Health. 2015;17(5):1487-95.

Pagaoa MA, Royce RA, Chen MP, Golub JE, Davidow AL, Hirsch-Moverman Y, Marks SM, Teeter LD, Thickstun PM, Katz DJ; Tuberculosis Epidemiologic Studies Consortium. Risk factors for transmission of tuberculosis among United States-born African Americans and Whitesexternal iconexternal icon. Int J Tuberc Lung Dis. 2015;19(12):1485-92.

* Note: persons identified as White, Black or African American, Asian, American Indian or 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.