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Prevalence of Tuberculosis Infection in the United States Population

The National Health and Nutrition Examination Survey, 1999–2000

Diane E. Bennett¹, Jeanne M. Courval², Ida Onorato^1,, Tracy Agerton¹, Judy D. Gibson¹, Lauren Lambert¹, Geraldine M. McQuillan³, Brenda Lewis³, Thomas R. Navin¹ and Kenneth G. Castro¹

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 10 mm. Associations of age, race/ethnicity, sex, poverty, and birthplace were assessed. Results among the 24- to 74-year-old subgroup were compared with NHANES 1971–1972 data.

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

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Estimated national prevalence of latent tuberculosis infection in the United States decreased from 14.3% in the early 1970s to 5.7% in 1999–2000 among persons 24–74 years of age. Rates of active TB disease also decreased from 15.8 to 5.6 per 100,000 during the same period in the U.S. population as a whole, but both of these reported decreases mask continuing high rates among important groups such as the foreign-born population and U.S.-born ethnic minorities. What This Study Adds to the Field Based on a representative national survey, latent TB infection prevalence in the United States was 4.2% in 1999–2000, with significantly higher rates in some subgroups. Only 25.5% of persons with latent TB infection had been diagnosed, and only 13.2% had been prescribed treatment.

 

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