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U.S. Department of Health and Human Services

  

TB Challenge: Partnering to Eliminate TB
in African Americans

TB in African Americans:
Data from the 2003 Surveillance Report

Michael Fraser, Public Health Advisor, DTBE/FSEB

Michael Fraser: What are the current tuberculosis (TB) case counts and rates for non-Hispanic blacks?  

Lori Armstrong: According to the DTBE's national tuberculosis surveillance system 2004 provisional data, there were 4,006 cases of TB in non-Hispanic blacks and a rate of 11.1 per 100,000.  There were 4,153 cases of TB in non-Hispanic blacks in 2003 and a rate of 11.7 per 100,000.    This represents a 4.6% decline in the rate for non-Hispanic blacks from 2003 to 2004.

MF: Looking at the period 1993 to 2003, please discuss some of the trends in this population.  In addition, what is the age and gender distribution of these cases?

LA: Over the period 1993 to 2003, TB rates in non-Hispanic blacks have fallen steadily (29.1/100,000 in 1993 to 11.7/ 100,000 in 2003).  This is a 60% decline in the case rate.  The percent decline in case rates for all TB cases during that time was only 48% (9.8/ 100,000 in 1993 to 5.1/100,000 in 2003). Although non-Hispanic blacks still had TB at a rate that was more than 2 times the national case rate in 2003, the rate has declined tremendously over the past decade.

In 2003, there were more TB cases in male non-Hispanic blacks (n=2531) than in females (n=1614) and, as one might expect, the rates for males were much higher (males 14.9/100,000, females 8.7/100,000).  This is the same pattern we see for every other racial/ethnic group in the United States.  The rate of TB also rises with age for all racial/ethnic groups, including non-Hispanic blacks.  The older the age group, the higher the rate.  As in other racial/ethnic groups, non-Hispanic blacks have their highest rate of TB among those over age 65 years (21.3/100,000).

MF: Do these data speak to why more non-Hispanic black men are at a higher risk for developing TB than women?  Why blacks in general versus whites are at a higher risk?

LA: Black non-Hispanic men are more likely than black non-Hispanic women to have risk factors that put them at greater risk for exposure for TB, thus at a greater risk for TB disease.  In 2003, black non-Hispanic men with TB were 3.5 times more likely than black non-Hispanic women with TB to be homeless, 3 times more likely to have used excess alcohol within the past year, and nearly 4 times more likely to live in a correctional facility at the time of diagnosis.  Homelessness is a major concern among non-Hispanic black TB patients.  Among all TB patients who were reported in 2003 as being homeless within the past year, 362 patients (about 40%) were non-Hispanic black, versus 28% who were white.

MF: For comparing with other populations, do CDC data or any projects or studies in your branch indicate that non-Hispanic blacks are more likely to have resided in a correctional facility or homeless shelter or that this group is less educated, and/or more impoverished?

LA:  Homeless status within the past year is collected by the national surveillance system, but we don't collect information on whether the person resided in a homeless shelter.  There are several efforts within DTBE to study socioeconomic factors that may contribute to TB disease, such as educational level or income level.  We don't collect these data in the national TB surveillance system, but geographically-based socioeconomic factors can be studied by linking the national surveillance data with U.S. Census data.  These studies examine the SES factors that are collected by the Census Bureau and are based on where the person lives, such as the zip code, census tract or block group. 

MF: Is CDC collaborating with other governmental and nongovernmental agencies to address this population that has been described as eight times more likely than non-Hispanic whites to develop TB disease?

LA: To address the high rate of TB in blacks in the United States, CDC has funded three demonstration projects in Chicago, Georgia, and South Carolina in collaboration with state and local health departments to identify innovative strategies for decreasing TB rates in African-American communities by improving TB diagnosis, screening, and treatment adherence in high-risk African-American communities.  CDC is also conducting a formative research and intervention study in collaboration with the Research Triangle Institute; this study will 1) examine barriers to health-seeking  behaviors and treatment adherence for blacks with or at risk for TB, 2) determine barriers to TB guideline adherence among providers who serve this population, 3) develop and test interventions to overcome identified barriers, and 4) improve partnerships and collaborations among TB programs, providers, and organizations serving this population. Ms. Gail Burns-Grant and Dr. Nick DeLuca, DTBE, serve as the project officers for these initiatives, respectively. Alongside state and local health departments, CDC is working to ensure that adequate local resources are in place in communities with the greatest burden of TB.

MF:  What was the completion of therapy rate in this group for 2003?

LA:  States have up to 2 years after the diagnosis year to report completion of therapy on TB cases.  Therefore, the most recent year that data are available is 2001.  That year, 81% of non-Hispanic blacks with TB completed therapy within 1 year of treatment (among those where 1 year of therapy or less was medically indicated).  This is comparable to 80.5% completion of treatment for all reported TB cases in the nation that year (among those cases where 1 year of therapy or less is medically indicated and who received treatment). The percentage of non-Hispanic blacks who receive directly-observed therapy is also very high: 83% in 2001, compared to 77% among non-Hispanic whites and 77% for all cases receiving treatment in 2001.

MF: Can you explain the national estimated HIV coinfection rates for non-Hispanic blacks and discuss what age groups are most impacted?

LA: In a DTBE study published last year, non-Hispanic blacks with TB reported in Southeastern states from 1991 to 2002 were more likely than whites to have certain risk factors, such as HIV infection, incarceration, or excess alcohol or drug use.  This suggests that differences in socioeconomic health status and opportunity for TB exposure underlie increased risk for TB.  For the most recent 5 years of available data, 1999 to 2003, 58% to 65% of all HIV-infected TB patients were non-Hispanic blacks, the highest percentage of any other racial/ ethnic group.  Among all non-Hispanic black TB patients, 18% to 19% were HIV-infected throughout that time period and most cases (29% to 33%) occurred among the 25- to 44-year age group.  We can reduce TB in non-Hispanic blacks by continuing to work closely and collaboratively with our partners.

MF:  Thank you.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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