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Michael F. Cantwell, MD, MPH; Dixie E. Snider, Jr, MD, MPH; George M. Cauthen, ScD; Ida M. Onorato, MD

JAMA. 1994;272(7):535-539.

Abstract
Objective.
—To examine the distribution and sources of increased tuberculosis (TB) morbidity in the United States from 1985 through 1992.

Design.
—Review of TB surveillance data.

Participants.
—All incident TB cases in the United States reported to the Centers for Disease Control and Prevention from 1980 through 1992.

Main Outcome Measures.
—Changes in reported number of TB cases from 1985 through 1992 were analyzed by sex, race/ethnicity, age, country of birth (1986 through 1992), site of disease, geographic location, and socioeconomic status (through 1991). From 1985 through 1992, reported number of cases was compared with expected number of cases, extrapolated from 1980 through 1984 trends, to estimate excess cases by sex, race/ethnicity, and age.

Results.
—Increases in number of cases from 1985 through 1992 were concentrated among racial/ethnic minorities, persons 25 to 44 years of age, males, and the foreign-born. Excess cases occurred in both sexes, all racial/ethnic groups, and all age groups. Foreign-born cases accounted for 60% of the total increase in the number of US cases from 1986 through 1992 and had the greatest impact among Asians, Hispanics, females, and persons other than those 25 to 44 years of age. Human immunodeficiency virus infection had the greatest impact on TB morbidity among whites, blacks, males, and persons 25 to 44 years of age. From 1985 through 1992, the number of cases among children 4 years old or younger increased 36%, suggesting that transmission of TB increased during this period.

Conclusions.
—Multiple factors contributed to the recent increases in the number of TB cases. The effectiveness of TB screening in immigrants needs further evaluation. Intensified efforts to determine the human immunodeficiency virus status of persons with TB are needed. Screening of subpopulations at increased risk for tuberculous infection or TB should be expanded.

(JAMA. 1994;272:535-539)

Author Affiliations
From the Division of Tuberculosis Elimination (Drs Cantwell, Cauthen, and Onorato), and the Office of the Director, (Dr Snider), National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, Ga.

Footnotes
Reprint requests to the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Rd, E-10, Atlanta, GA 30333 (Dr Cantwell).

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