• Yunfei Li, Mathilda Regan, Nicole A Swartwood, Terrika Barham, Garrett R Beeler Asay, Ted Cohen, Andrew N Hill, C Robert Horsburgh, Awal Khan, Suzanne M Marks, Ranell L Myles, Joshua A Salomon, Julie L Self, and Nicolas A Menzies.
• Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Y.L., M.R., N.A.S.).
• Ann. Intern. Med. 2024 Apr 1; 177 (4): 418427418-427.

BackgroundElevated tuberculosis (TB) incidence rates have recently been reported for racial/ethnic minority populations in the United States. Tracking such disparities is important for assessing progress toward national health equity goals and implementing change.ObjectiveTo quantify trends in racial/ethnic disparities in TB incidence among U.S.-born persons.DesignTime-series analysis of national TB registry data for 2011 to 2021.SettingUnited States.ParticipantsU.S.-born persons stratified by race/ethnicity.MeasurementsTB incidence rates, incidence rate differences, and incidence rate ratios compared with non-Hispanic White persons; excess TB cases (calculated from incidence rate differences); and the index of disparity. Analyses were stratified by sex and by attribution of TB disease to recent transmission and were adjusted for age, year, and state of residence.ResultsIn analyses of TB incidence rates for each racial/ethnic population compared with non-Hispanic White persons, incidence rate ratios were as high as 14.2 (95% CI, 13.0 to 15.5) among American Indian or Alaska Native (AI/AN) females. Relative disparities were greater for females, younger persons, and TB attributed to recent transmission. Absolute disparities were greater for males. Excess TB cases in 2011 to 2021 represented 69% (CI, 66% to 71%) and 62% (CI, 60% to 64%) of total cases for females and males, respectively. No evidence was found to indicate that incidence rate ratios decreased over time, and most relative disparity measures showed small, statistically nonsignificant increases.LimitationAnalyses assumed complete TB case diagnosis and self-report of race/ethnicity and were not adjusted for medical comorbidities or social determinants of health.ConclusionThere are persistent disparities in TB incidence by race/ethnicity. Relative disparities were greater for AI/AN persons, females, and younger persons, and absolute disparities were greater for males. Eliminating these disparities could reduce overall TB incidence by more than 60% among the U.S.-born population.Primary Funding SourceCenters for Disease Control and Prevention.

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