• Sarah T Cherng, Sourya Shrestha, Sue Reynolds, Andrew N Hill, Suzanne M Marks, Jane Kelly, and David W Dowdy.
• Sarah T. Cherng, Sourya Shrestha, and David W. Dowdy are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Sue Reynolds, Andrew N. Hill, and Suzanne M. Marks are with the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA. Jane Kelly is with the Georgia Department of Public Health, Atlanta.
• Am J Public Health. 2018 Nov 1; 108 (S4): S311-S314.

ObjectivesTo illustrate the magnitude of between-state heterogeneities in tuberculosis (TB) incidence among US populations at high risk for TB that may help guide state-specific strategies for TB elimination.MethodsWe used data from the National Tuberculosis Surveillance System and other public sources from 2011 to 2015 to calculate TB incidence in every US state among people who were non-US-born, had diabetes, or were HIV-positive, homeless, or incarcerated. We then estimated the proportion of TB cases that reflected the difference between each state's reported risk factor-specific TB incidence and the lowest incidence achieved among 4 states (California, Florida, New York, Texas). We reported these differences for the 4 states and also calculated and aggregated across all 50 states to quantify the total percentage of TB cases nationally that reflected between-state differences in risk factor-specific TB incidence.ResultsOn average, 24% of recent TB incidence among high-risk US populations reflected heterogeneity at the state level. The populations that accounted for the greatest percentage of heterogeneity-reflective cases were non-US-born individuals (51%) and patients with diabetes (24%).ConclusionsState-level differences in TB incidence among key populations provide clues for targeting state-level interventions.

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