epidemiology of tuberculosis in african-american population, united states 1993-2005 kenneth g....
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![Page 1: Epidemiology of Tuberculosis in African-American Population, United States 1993-2005 Kenneth G. Castro, M.D. Assistant Surgeon General, USPHS Director,](https://reader036.vdocuments.mx/reader036/viewer/2022062517/56649f155503460f94c29de9/html5/thumbnails/1.jpg)
Epidemiology of Tuberculosis in
African-American Population,United States 1993-2005
Kenneth G. Castro, M.D.Assistant Surgeon General, USPHS
Director, Division of Tuberculosis EliminationNational Center for HIV, Hepatitis, STD, and TB Prevention*
Coordinating Center for Infectious Diseases
Stop TB in the African-American CommunityMay 16-17, 2006Atlanta, Georgia
*Proposed
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*Data for 2005 are provisional.
Reported TB Cases United States, 1982–2005*
10,00012,00014,00016,00018,00020,00022,00024,00026,00028,000
1983 1987 1991 1995 1999 2005
Year
No
. of
Ca
ses 14,093
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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 orOther 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. 2005 data provisional
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Reported TB Cases in U.S.-born and Foreign-born, by Race/Ethnicity. U.S.
1993–2004 U.S.-born Foreign-born
TotalN % N %
White, Non-Hispanic 47534 89 6111 11Black, Non-Hispanic 61379 85 10924 15Hispanic 16613 32 34655 68American Indian/ Alaska Native
2881 98 63 2
Asian/Pacific Islander 2561 6 40862 94
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Reported TB Cases in U.S.-born, by Race/Ethnicity, U.S., 1993–2004
N %
White, Non-Hispanic 47534 36
Black, Non-Hispanic 61379 47
Hispanic 16613 13
American Indian/ Alaska Native
2881 2
Asian/Pacific Islander 2561 2
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Characteristics Among Selected U.S.-born Persons with TB, 2004
Black* White*
No. cases 2,675 2,209
Male 70% 67%
Median age (years)
46 57
*Non-Hispanic
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1
10
100
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
TB Rates in U.S.-born, by Race/Ethnicity,United States, 1993–2004
TB
Ca
ses
/10
0,00
0(l
og
sc
ale
)
Black, non-Hispanic White, non-Hispanic
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< 99
100–399
> 400
D.C.
TB Cases in U.S.-born African Americans, United States, 2000–2004
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Percent of TB Cases in Persons with History of Substance Abuse,* 1993–2004
01020304050607080
Black** White**
Per
cen
t
*Injecting drug, non-injecting drug, or excess alcohol use in year prior to TB diagnosis**U.S.-born non-Hispanic
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Estimated HIV Coinfection in Persons Reported with TB, 1993–2004
0
10
20
30
Black* White*
% C
oin
fect
ion
*U.S.-born non-HispanicNote: Minimum estimates based on reported HIV-positive status among all TB cases in the race group.
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Percent of Persons with TB Diagnosed in a Correctional Facility, 1993-2004
02468
10
Per
cen
t
Black* White*
* U.S.-born non-Hispanic
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Percent of TB Cases in Homeless Persons (Year Prior to Diagnosis), 1993-2004
0
5
10
15
Per
cen
t
Black* White** U.S.-born non-Hispanic
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Percent of TB Cases in Unemployed Persons (in 2 Years Prior to Diagnosis), 1994-2004
0
20
40
60
80
Per
cen
t
Black* White*
* U.S.-born non-Hispanic
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Percent of U.S.-born Persons with TB, by Race/Ethnicity and Health Provider Type,
2004
Provider Type*
Health department 59 50
Private/other 17 21
Both 23 27
Black** White**
*For all outpatient care**U.S.-born non-Hispanic
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Reported TB Cases, by Completion of Therapy, U.S.,1993–2002
Overall Completion
Rate (%)
Completed within 1 year
(%)White, Non-Hispanic 86 76 Black, Non-Hispanic 85 72 Hispanic 81 73 American Indian/ Alaska Native 88 79 Asian/Pacific Islander 83 76
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Completion of TB Therapy in 1-Year
United States, 1993–2002
0
20
40
60
80
100
Black* White*
*U.S.-born non-HispanicExcludes persons with initial isolate resistant to rifampin and children under 15 years old with meningeal, bone or joint, or miliary disease.
Per
cen
t
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Summary • TB rates steadily declined between 1993-2004 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 1993-2004. 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
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"Insanity is doing the same thing over and over again and expecting
different results."
─ Albert Einstein
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“…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.”
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Characteristics of Selected U.S.-born Persons with TB, 2004
Characteristic** No. (%) No. (%)
MDR TB 12 (0.5) 10 (0.5)
HIV-positive 488 (16) 89 (4)
Substance abuse 1001 (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 completeSubstance abuse defined as injecting drug, non-injecting drug, or excess alcohol use in year prior to TB diagnosis.
Black* White*