Tuberculosis — United States, 2022

The reported tuberculosis (TB) incidence gradually decreased in the United States between 1993 and 2019, reaching 2. 7 cases compared to another 100,000 people in 2019. The incidence dropped especially in 2020 to 2. 2, coinciding with the pandemic of COVID-19. [1] Proposed explanations for the decline come with delayed or missed TB diagnoses, adjustments in migration and travel, and mortality among those most likely to reactivate TB. [1] Disparities (eg, based on race and ethnicity) in the occurrence of TB have been described. [2] In 2021, the TB incidence partially recovered (to 2. 4), but remained particularly lower than in pre-pandemic years, raising considerations about continued delays in diagnosis. [1] In 2022, the 50 US states and the District of Columbia (DC) provisionally reported 8,300 TB cases to the National Tuberculosis Surveillance System. Tuberculosis incidence was calculated using mid-year population estimates and stratified by origin at birth and by race and ethnicity. In 2022, the incidence of tuberculosis increased slightly to 2. 5, although it was still lower than in the pre-pandemic years. * Compared to 2021, the epidemiology of tuberculosis in 2022 was characterized by more cases among people born abroad and new in the country. the United States; consistent with the occurrence of tuberculosis in non-Hispanic American Indians/Alaskan Natives (AI/AN) and non-Hispanic Hawaiians/Other Pacific Islanders (NH/OPI) and the elderly ≤4 years and 15–24 years; and a slight decrease in incidence in other people older than 65 years. The occurrence of tuberculosis appears to be returning to pre-pandemic levels. TB disparities persist; addressing these disparities requires initial TB diagnosis and treatment to interrupt TB transmission and prevention through treatment of latent TB infection (LTBI).

The fitness departments of all 50 U. S. statesThe U. S. and U. S. Department of State and DC electronically report verified TB cases to CDC based on the Council of State and Territorial Epidemiologists’ definition of a surveillance case: stratified occurrence of tuberculosis. People with TB are grouped by self-reported race and ethnicity according to federal guidelines. ¶ People who report Hispanic ethnicity are classified as Hispanic or Latino (Hispanic), regardless of race. Non-Hispanics are classified by race; The other non-Hispanic people who reported more than one race are classified as “multiple races. “Mid-year population estimates from the Current Population Survey** are used to calculate occurrence through source of birth in the United States (born in the United States as opposed to non-born in the United States)†† and based on race and ethnicity. This activity was reviewed by CDC and conducted in accordance with applicable federal law and CDC policy. §§

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Tuberculosis*,† Cases and Occurrence by Origin Prestige at Birth in the United States§,¶ — National Tuberculosis Surveillance System, United States, 2012-2022 *Number of cases is based on System knowledge National Tuberculosis Surveillance as of March 6, 2023. † Cases consistent with 100,000 inhabitants. The Current Population Survey provides population denominators used to calculate TB incidence across national origin and racial/ethnic group. https://www. census. gov/programs-surveys/cps. html (accessed February 3, 2023) §A user is considered to have been born in the United States if he or she is eligible for US citizenship at birth, regardless of where you were born Origin of birth is missing or unknown in 232 (2. 8%) instances in 2022. Of these, 180 (77. 6%) had a country of birth recorded and the origin of birth was explained as born in the United States for those who reported a birth in the United States or US territories and as not born in the United States for users born outside the United States and its territories. ¶People whose origin of birth is unknown (range = 2 [2012] to 52 [2022]).

In 2022, there were 6,009 cases of TB in other foreign-born people; >80% of those cases were Asian (2632; 44%) or Hispanic (2194; 37%). The remaining cases occurred among blacks (625; 10%), whites (276; 5%), and NH/IPO (103; 2%), and others who were multiracial or whose race and ethnicity were unknown (177; 3%). In 2022, as among those born in the U. S. , the U. S. will be able to do so. NH/IPO other people. The next highest occurrence (22. 0) occurred in other Asian people, followed by blacks (13. 7), Hispanics (10. 1), AI/AN (4. 3), and whites (3. 4). Among those groups, the largest increase in occurrence from 2021 to 2022 (221%) occurred among AI/YEAR individuals, followed by NH/ICP (20%), Hispanics (13%), and whites (7%). The occurrence decreased to 12% among blacks and 7% among Asians in 2022.

Among other people with TB who were not born in the U. S. In the U. S. in 2022, 16. 5% (992) were diagnosed <1 year after their initial arrival in the U. S. In the U. S. , compared to 9. 8% (553) in 2021. La newly diagnosed TB had been living in the United States for more than 10 years in 2022 (2821; 46. 9%) compared to 2021 (2845; 50. 2%).

*This report is limited to the knowledge of the National TB Surveillance System tentatively reported across the five US states and DC as of March 6, 2023. Updated knowledge will be found in the annual TB Surveillance Report. CDC TB later in 2023. †TB cases are verified based on the case definition for public fitness surveillance, which includes laboratory criteria, clinical criteria, or provider diagnosis. https://ndc. services. cdc. gov/case-definitions/tuberculosis-2009/ §Used short-term projections of population estimates by month by age, sex, race, and Hispanic origin for the 2022 population, estimates of The 2021 seniority population was used for 2021 and 2020, and the 2010 seniority population estimates were used for 2012-2019. https://www. census. gov/programs-surveys/popest/knowledge/tables. html; https://www. census. gov/programs-surveys/popest/knowledge/tables. 2019. List_five8029271. html#list-tab-List_five8029271 ¶ https://www. census. gov/topics/population/race/about. html ** https: //www. census. gov/programs-surveys/cps. html †† A user is considered to have been born in the United States if he or she is eligible for US citizenship at birth, regardless of the residency position of she. birth. Origin of birth was missing or unknown in 232 (2. 8%) cases in 2022. Of these, 180 (77. 6%) had a reported country of birth, and origin of birth was explained as born in the United States for users who reported a birth. in the United States or US territories. and as born outside the US for users born outside the United States and its territories. §§ forty-five C. F. R. component 46. 102(l)(2), 21 C. F. R. component five6; 42 USC Sect. 241(d); five U. S. C. Sect. fivefive2a; 44 USC Sect. 3five01 et seq. ¶¶ Proportions using origin of birth are calculated from unknown. ***Restocking percentage is calculated from non-rounded numbers. For demographic teams with small populations (eg, RN/AN users born outside of the United States), adjustments to occurrence rates should be interpreted with caution due to the greater volatility of those rates. Matrix †††Percentages are calculated using instances with full knowledge for each of those 3 individual variables.

*Case counts are based on knowledge reported to the National TB Surveillance System as of 6 March 2023. † Incidence is calculated on a case-per-100,000 U. S. population estimates basis. Age, sex, race, and Hispanic origin were used for the 2022 population, 2021 population estimates were used for 2021 and 2020, and 2010 population estimates were used for 2019. https://www. census. gov/programs-surveys /popest/conocimiento/tablas. html; https://www. census. gov/programs-surveys/popest/knowledge/tables. 2019. List_58029271. html#list-tab-List_58029271

Abbreviations: AI/AN = Native American or Alaska Native; NA = not applicable; NH/OPI = Native Hawaiian or Other Pacific Islander; TB = tuberculosis. *Case counts are based on knowledge reported to the National Tuberculosis Surveillance System as of March 6, 2023. †Percentages are calculated only among patients for whom knowledge is available, for years after arrival in hospitals. USA. The age was missing or unknown for 0 instances in 2021 and 3 instances in 2022; the origin of birth remained non-existent or unknown in 28 cases in 2021 and 52 cases in 2022; race and ethnicity were missing or unknown in 56 instances in 2021 and 175 instances in 2022; HIV test effects were missing or unknown in 842 cases in 2021 and 1,270 cases in 2022; if a homeless user was missing or unknown for 60 instances in 2021 and 301 instances in 2022; if a user living in a correctional facility was missing or unknown in 92 instances in 2021 and 215 instances in 2022; and whether a user resided in a long-term care facility was missing or unknown in 81 cases in 2021 and 215 cases in 2022. §Incidence is calculated as cases consistent with another 100,000 people using networked population estimates from the US Census Bureau 2022 population used short-term projections of month-consistent population estimates across age, sex, race, and Hispanic origin, 2021 population estimates used for 2021 and 2020, and 2010 population estimates used for 2019. https://www. census. gov/programs-surveys/popest/knowledge/tables. html; https://www. census. gov/programs-surveys/popest/knowledge/tables. 2019. List_58029271. html#list-tab-List_58029271 ¶A user is considered to be born in the United States if they are eligible for US citizenship at born, regardless of the position of birth. Origin of birth was missing or unknown in 232 (2. 8%) cases in 2022. Of these, 180 (77. 6%) had a reported country of birth, and origin of birth was explained as born in the United States for users who reported a birth. in the United States or US territories. and as born outside the US for users born outside the United States and its territories. **Excluded from race and ethnicity subtotals.

Kimberly R. Schildknecht, MPH1,2, Robert H. Pratt2, Pei-Jean I. Feng, MPH2, Sandy F. Price2 and Julie L. Self, PhD2 1Epidemic Intelligence Service, CDC; 2Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STDs, and Tuberculosis Prevention, CDC.

Correspondent Kimberly R. Schildknecht, trg8@cdc. gov.

All authors completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

What do we already know about this topic?

At the beginning of the COVID-19 pandemic (2020), the incidence of reported tuberculosis (TB) in the United States decreased significantly. The incidence recovered in 2021, but remained below the incidence in the years prior to the pandemic.

What does this bring?

In 2022, the incidence of tuberculosis reported has increased slightly. Among other people with TB who were not born in the United States, the proportion of others who had recently arrived in the United States is higher. The higher incidence of tuberculosis among American Indians or Alaska Natives and Native Hawaiians or other Pacific Islanders versus other racial and ethnic teams represents an ongoing disparity in physical fitness.

What are the implications for public practice?

The occurrence of TB is returning to pre-pandemic levels. TB diagnosis and treatment to interrupt TB transmission and prevention through treatment of latent TB infection is critical to TB elimination efforts in the United States.

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