Understanding Tuberculosis (TB) Disparities in the US


Study addresses the racial and ethnic inequalities in TB incidence rates.

4 samples of TB testing.

Image Credits: Unsplash

4 samples of TB testing.

Image Credits: Unsplash

Persistent disparities exist in TB incidence across different races/ethnicities, according to an analysis of national disease registry data published in the Annals of Internal Medicine. Relative disparities were more significant for American Indian or Alaska Native (AI/AN) individuals, females, and younger people, while absolute disparities were more pronounced for males. Elimination has the potential to lower overall TB incidence by over 60% among the US-born population.

TB incidence rates across racial/ethnic groups compared to non-Hispanic White individuals show the incidence rate ratios reached up to 14.2 (95% CI, 13.0 to 15.5) for AI/AN females. From 2011 to 2021, excess TB cases comprised 69% (CI, 66% to 71%) of all cases in females and 62% (CI, 60% to 64%) for males. There was no evidence indicating a decrease in incidence rate ratios over time, with most measures of relative disparity showing small increases.

“For both females and males, the number of excess TB cases (calculated by comparing observed case totals with a hypothetical scenario in which TB incidence rates for each racial/ethnic population were reduced to match the values estimated for the reference White population) represented more than half of all TB cases recorded during 2011 to 2021,” according to the investigators. “Similar patterns were estimated when analyses were stratified by age group, with greater relative disparities estimated for younger age groups.”

Main Takeaways

  1. Disparities in TB incidence across different racial and ethnic groups in the US with AI/AN, females, and younger populations experiencing higher relative disparity.
  2. Addressing these disparities could lead to a significant decrease in overall TB incidence among the US-born population, with the potential to lower it by over 60%.
  3. Achieving health equity and advancing toward TB elimination requires continuous monitoring of disparities and actions to remove barriers to accessible and effective TB prevention and treatment for all.

The analyses operated under the assumption of complete TB case diagnosis and self-reporting of race/ethnicity, without adjustments made for medical comorbidities or social determinants of health.

“Absolute disparity measures decreased over the study period, mirroring decreases in population-average incidence rates, whereas relative disparity measures were generally flat. For AI/AN females and males populations with large relative disparities and small denominators, incidence rate ratios widened progressively over the study period in regression models, but these trends were not statistically significant.”

The study has limitations, it did not explore the mechanisms behind the observed racial/ethnic disparities in TB incidence over time, for informing effective public health interventions. The analysis assumes complete TB case detection and reporting, which might not account for undetected cases, especially in populations with limited healthcare access. Based on spatial and genomic data, the method to determine TB transmission lacks information for multiple cases. The study did not examine variations in disparities at subnational levels, where specific interventions, like Medicaid expansion, could have differing impacts.

These limitations underscore the importance of ongoing research to delve deeper into the causes of these disparities and develop more effective strategies for their eradication. Despite strides in reducing TB incidence rates in the US, persistent racial and ethnic disparities underscore the need for targeted public health strategies. Achieving health equity and advancing towards TB elimination demand not only ongoing disparity monitoring but also actions to dismantle barriers to accessible and effective TB prevention and treatment for all.


Li Y, Regan M, Swartwood N, et. al. Disparities in Tuberculosis Incidence by Race and Ethnicity Among the U.S.-Born Population in the United States, 2011 to 2021: An Analysis of National Disease Registry Data. Annals of Internal Medicine. Published April 2, 2024. Accessed April 11, 2024. Doi: https://doi.org/10.7326/M23-2975

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