Study: Tuberculosis Is on the Rise in Big U.S. States

The global tuberculosis epidemic contributed to the rise in cases last year in California, Texas and other U.S. states with large immigrant populations, a CDC study reported Thursday. Of the 14,871 new cases of active TB in the United States last year, more than 53 percent occurred among people born abroad to non-U.S.-born parents. Five years ago, foreign-born patients made up 41.7 percent of the nation's TB caseload.

The proportion of cases among the foreign-born -- who comprise about 11.5 percent of the overall U.S. population -- was the highest since the United States began collecting birthplace data for TB patients in 1986. Though TB cases fell in the nation as a whole, cases rose in California, New York, Texas and 16 other states in 2003.

The 1.9 percent drop in the US tuberculosis infection rate last year was the smallest decline since 1992, when TB peaked, said Dr. Eileen Schneider, an epidemiologist with CDC's TB elimination division. "We're not sure if this is just a plateau or a resurgence," said Schneider, adding that a decline in TB among U.S.-born residents contributed to the increasing percentage of foreign-born patients represented in the 2003 data.

Last year, Mexicans account for about one-quarter of foreign-born U.S. TB patients. Filipinos, Indians, Chinese and Vietnamese also had high TB infection rates.

CDC is working to improve TB screening of U.S. visa applicants overseas and high-risk groups within the United States. CDC hopes to establish a closer relationship with authorities fighting TB along the U.S.-Mexican border. The three most populous states -- California and Texas, which both share a border with Mexico, and New York -- accounted for 42.4 percent of TB cases in 2003.

The CDC study also revealed high TB infection rates in blacks and other minorities. Last year, U.S.-born blacks were about 7.5 times more likely than whites to have TB.

The study, "Trends in Tuberculosis -- United States, 1998-2003," was published in Morbidity and Mortality Weekly Report (2004;53(10):209-214).

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