Regional Differences in Tuberculosis in the U.S.

Tuberculosis (TB) control programs are largely planned and carried out by states, and the TB epidemic in the U.S. is not homogeneous. To examine how heterogeneities at the state level may affect TB incidence, researchers constructed an individual-level model of TB using data from the four states that account for half of all reported incident cases, California (CA), Florida (FL), New York (NY), and Texas (TX). From these data, they created best-fit models that projected the TB incidence for each state through 2025.

The percentages and origins of foreign-born residents differed greatly among the states (e.g., accounting for 27% of the population in CA vs. 17% in TX). In TX, 56% of foreign-born were from Mexico compared with 6% in NY, whereas Asians accounted for 38% in CA compared with 11% in FL. Similarly, TB incidence between 2009 and 2013 varied from 3.8 per 100,000 in FL to 5.9 per 100,000 in CA. Finally, declines in recent TB transmission rates were estimated to be highest in CA and NY, while reactivations from latent infection were highest in TX. Based on these data, the projected median annual rate of decline in TB incidence by 2025 was estimated to be 1.5% in Florida, 1.7% in CA, 1.9% in NY, and 3.3% in TX.