African–American Community

Tuberculosis in Black/African American Populations

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* blacks/African Americans have been cut in half (from 8.8 cases per 100,000 persons in 2008 compared to 4.4 in 2018) over the past decade.

However, black/African American populations in the United States continue to have a disproportionately higher burden of TB.

Addressing the TB disparity among blacks/African Americans is an important priority; prevention and control efforts should be targeted to this population.

The Numbers

In 2018, U.S. state, local, and territorial health agencies reported 9,025 TB cases to CDC.

  • TB disease was reported in 1,799 non-Hispanic blacks/African Americans in the United States, accounting for 20% of all people reported with TB nationally.
  • Among U.S.-born people reported with TB disease, 35.7% were non-Hispanic blacks/African Americans.
    • Both of these proportions are high considering black/African Americans make up only 12.5% of the U.S. population.
  • The rate of TB disease in non-Hispanic blacks/African Americans was 4.4 cases per 100,000 population, which is over eight times higher than the rate of TB disease in non-Hispanic whites (0.5 cases per 100,000 population).
The distribution of TB patients by race/ethnicity continued to differ markedly by origin of birth. Among US-born TB patients, the largest racial/ethnic group was non-Hispanic blacks (35.7%), followed by non-Hispanic whites (30.3%), Hispanics (22.1%), and non-Hispanic Asians (5.1%). Approximately half of TB cases reported among non-US–born persons occurred among non-Hispanic Asians (48.1%), but followed by Hispanics (31.9%), non-Hispanic blacks (13.4%), and non-Hispanic whites (4.2%).

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 at highest risk for TB, and to identify and implement innovative strategies to improve testing and treatment.

TB rates are higher for some racial and ethnic groups. Like other communities, blacks/African Americans may face a number of challenges that contribute to higher rates of TB. Challenges include:

  • Treatment duration and completion
      • Treatment for TB disease is 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, seeking and completing treatment for a condition with no symptoms of illness is often not a priority.
  • Socioeconomic factors
      • Poverty, including limited access to quality health care, unemployment, housing, and transportation can directly or indirectly increase the risk for TB disease and present barriers to treatment of this disease.
      • 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.
      • Blacks/African Americans have the most severe burden of HIV of all racial/ethnic groups in the United States. Compared with other races and ethnicities, Blacks/African Americans account for a higher proportion of HIV infections at all stages of disease—from new infections to deaths.
      • Blacks/African Americans accounted for an estimated 53% of all new HIV infections among adults and adolescents (aged 13 years or older)  in 2018, despite representing only 13% of the U.S. population.
      • 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.
  • Delayed diagnosis
    • Delayed detection and diagnosis of TB disease, as well as delayed reporting of TB disease remains a challenge in TB prevention and treatment. Because the number of TB cases in the United States is declining, there is decreased awareness of TB signs and symptoms among health care providers and at-risk populations. Patients may be less likely to seek medical care and health care providers may be less likely to consider TB as the cause.

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 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 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 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 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 icon. Int J Tuberc Lung Dis. 2015;19(12):1485-92.

* Note: 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.

Page last reviewed: May 17, 2019