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Published ahead of print on November 20, 2007, doi:10.1164/rccm.200706-950OC

Am. J. Respir. Crit. Care Med., Volume 177, Number 4, February 2008, 455-460

A more recent version of this article appeared on February 15, 2008
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Submitted on June 27, 2007
Accepted on November 19, 2007

Tuberculosis Infection in the United States: National Trends Over Three Decades

Kamran Khan1*, Jun Wang2, Wei Hu2, Arlene Bierman2, Yukit Li3, and Michael Gardam4

1 St. Michael's Hospital, Centre for Research on Inner City Health, Toronto, Ontario, Canada; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Division of Infectious Diseases, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada, 2 St. Michael's Hospital, Centre for Research on Inner City Health, Toronto, Ontario, Canada; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada, 3 Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada, 4 Division of Infectious Diseases, University of Toronto, University Health Network, Toronto, Ontario, Canada

* To whom correspondence should be addressed. E-mail: km.khan{at}utoronto.ca.

Rationale: In 1989, the United States embarked upon an ambitious plan to eliminate tuberculosis nationwide. Although incidence rates of tuberculosis disease in the United States are declining, these cases represent only a tiny fraction of all tuberculosis infections. Understanding national trends in tuberculosis infection may be important in anticipating future trends in tuberculosis disease. Objectives: Describe the epidemiology of Mycobacterium tuberculosis infection in the United States in 1971-1972 and 1999-2000. Methods: We studied nationally representative cohorts of the United States non-institutionalized civilian population participating in the 1971-1972 and 1999-2000 National Health and Nutrition Examination Surveys. Participants were tuberculin skin tested and the epidemiology of tuberculosis infection was compared across surveys. Logistic regression was used to identify associations between participant and household characteristics and tuberculosis infection. Measurements and Main Results: In 1999-2000, 4.2% (95% CI: 3.3-5.2%) of the United States population aged one year or older displayed evidence of tuberculosis infection. Among persons aged 25-74, the prevalence of infection decreased from 14.4% in 1971-1972 (95% CI: 11.6-17.7%) to 5.6% in 1999-2000 (95% CI: 4.4-7.1%). Declines in the relative burden of infection among persons aged 25-74 were greater in the United States born population (12.6% to 2.5%) compared with the nation's foreign born population (35.9% to 21.3%). Conclusions: The United States has experienced a substantial decline in the burden of tuberculosis infection since the early 1970s. Despite this, the prevalence of infection among the nation's foreign born population is over eight times greater than that observed in the United States born population.
Key words: Tuberculosis, United States, Public Health, Emigration and Immigration, Tuberculin Test.




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