Epidemiology of Tuberculosis in African-American Population, United States Kenneth G. Castro, M.D. Assistant Surgeon General, USPHS Director, Division of Tuberculosis Elimination National Center for HIV, Hepatitis, STD, and TB Prevention* Coordinating Center for Infectious Diseases Stop TB in the African-American Community May 16-17, 2006 Atlanta, Georgia *Proposed

*Data for 2005 are provisional. Reported TB Cases United States, 1982–2005* Year No. of Cases 14,093

Reported TB Cases by Race/Ethnicity, United States, 2005* Hispanic or Latino (29%) Black or African American (28%) Asian (23%) White (18%) American Indian or Alaska Native (1%) Native Hawaiian or Other Pacific Islander (<1%) *All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases and are not shown data provisional

Reported TB Cases in U.S.-born and Foreign-born, by Race/Ethnicity. U.S – 2004 U.S.-bornForeign-born Total N %N% White, Non-Hispanic Black, Non-Hispanic Hispanic American Indian/ Alaska Native Asian/Pacific Islander

Reported TB Cases in U.S.-born, by Race/Ethnicity, U.S., 1993–2004 N% White, Non-Hispanic Black, Non-Hispanic Hispanic American Indian/ Alaska Native Asian/Pacific Islander 25612

Characteristics Among Selected U.S.-born Persons with TB, 2004 Black*White* No. cases2,6752,209 Male70%67% Median age (years) 4657 *Non-Hispanic

TB Rates in U.S.-born, by Race/Ethnicity, United States, 1993 – 2004 TB Cases /100,000 (log scale) Black, non-HispanicWhite, non-Hispanic

< –399 > 400 D.C. TB Cases in U.S.-born African Americans, United States, 2000 – 2004

Percent of TB Cases in Persons with History of Substance Abuse,* 1993 – 2004 Percent *Injecting drug, non-injecting drug, or excess alcohol use in year prior to TB diagnosis **U.S.-born non-Hispanic

Estimated HIV Coinfection in Persons Reported with TB, 1993 – 2004 % Coinfection *U.S.-born non-Hispanic Note: Minimum estimates based on reported HIV-positive status among all TB cases in the race group.

Percent of Persons with TB Diagnosed in a Correctional Facility, * U.S.-born non-Hispanic

Percent of TB Cases in Homeless Persons (Year Prior to Diagnosis), * U.S.-born non-Hispanic

Percent of TB Cases in Unemployed Persons (in 2 Years Prior to Diagnosis), * U.S.-born non-Hispanic

Percent of U.S.-born Persons with TB, by Race/Ethnicity and Health Provider Type, 2004 Provider Type* Health department 5950 Private/other1721 Both2327 Black** White** * For all outpatient care **U.S.-born non-Hispanic

Reported TB Cases, by Completion of Therapy, U.S.,1993–2002 Overall Completion Rate (%) Completed within 1 year (%) White, Non-Hispanic 8676 Black, Non-Hispanic 8572 Hispanic 8173 American Indian/ Alaska Native 8879 Asian/Pacific Islander 8376

Completion of TB Therapy in 1-Year United States, 1993–2002 *U.S.-born non-Hispanic Excludes persons with initial isolate resistant to rifampin and children under 15 years old with meningeal, bone or joint, or miliary disease. Percent

Summary TB rates steadily declined between in all race/ethnic groups; African-Americans are largest U.S.-born group (47%) TB rates among African-Americans consistently >8 times higher than whites throughout Closing the race/ethnic gap crucial to elimination Geographic concentration of TB in African-Americans in Southeast and Northeast TB in African-Americans associated with HIV, substance abuse, incarceration Completion of therapy similar and improving in both groups

"Insanity is doing the same thing over and over again and expecting different results." ─ Albert Einstein

“…the issue now confronting the nation is whether we will allow another cycle of neglect to begin or, instead, whether we will take decisive action to eliminate tuberculosis.”

Characteristics of Selected U.S.-born Persons with TB, 2004 Characteristic**No. (%) MDR TB12 (0.5)10 (0.5) HIV-positive488 (16)89 (4) Substance abuse1001 (34)609 (27) *U.S.-born non-Hispanic **MDR TB defined as resistance to at least isoniazid and rifampin. HIV data: for year 2004 may not be complete Substance abuse defined as injecting drug, non-injecting drug, or excess alcohol use in year prior to TB diagnosis. Black* White*