Published ahead of print on November 7, 2007, doi:10.1164/rccm.200701-057OC
© 2008 American Thoracic Society doi: 10.1164/rccm.200701-057OC
Prevalence of Tuberculosis Infection in the United States PopulationThe National Health and Nutrition Examination Survey, 1999–2000![]() 1 Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia; 2 RTI International, Atlanta, Georgia; and 3 Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland Correspondence and requests for reprints should be addressed to Thomas R. Navin, M.D., 1600 Clifton Rd., Mailstop E-10, Atlanta, GA 30333. E-mail: tnavin{at}cdc.gov Rationale: The goal for tuberculosis (TB) elimination in the United States is a TB disease incidence of less than 1 per million U.S. population by 2010, which requires that the latent TB infection (LTBI) prevalence be less than 1% and decreasing. Objectives: To estimate the prevalence of LTBI in the U.S. population.
Methods and Measurements: Interviews and medical examinations, including tuberculin skin testing (TST), of 7,386 individuals were conducted in 1999–2000 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the civilian, noninstitutionalized U.S. population. LTBI was defined as a TST measurement of Measurements and Main Results: Estimated LTBI prevalence was 4.2%; an estimated 11,213,000 individuals had LTBI. Among 25- to 74-year-olds, prevalence decreased from 14.3% in 1971–1972 to 5.7% in 1999–2000. Higher prevalences were seen in the foreign born (18.7%), non-Hispanic blacks/African Americans (7.0%), Mexican Americans (9.4%), and individuals living in poverty (6.1%). A total of 63% of LTBI was among the foreign born. Among the U.S. born, after adjusting for confounding factors, LTBI was associated with non-Hispanic African-American race/ethnicity, Mexican American ethnicity, and poverty. A total of 25.5% of persons with LTBI had been previously diagnosed as having LTBI or TB, and only 13.2% had been prescribed treatment. Conclusions: In addition to basic TB control measures, elimination strategies should include targeted evaluation and treatment of individuals in high-prevalence groups, as well as enhanced support for global TB prevention and control.
Key Words: tuberculosis infection tuberculin test epidemiology United States
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