Trends in Tuberculosis, 2019

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The United States continues to have one of the lowest TB case rates in the world, and the 2019 case count represents the lowest number of TB cases on record. Still, too many people suffer from TB disease and our progress is too slow to eliminate TB in this century.

Ending TB will require a dual approach of maintaining and strengthening current TB control priorities, while increasing efforts to identify and treat latent TB infection in populations at risk for TB disease.

During 2019, the United States reported the lowest number of TB cases (8,916) and lowest incidence rate (2.7 cases per 100,000 persons) since individual TB case reporting began in 1953.
This represents a 1.2% decrease in TB cases and 1.7% decrease in the incidence rate from 2018 (an 89.5% decrease in TB cases and a 95% decrease in TB incidence rate since 1953).
2019

  • In 2019, the majority (51%) of U.S. TB cases continued to be reported from 4 states: California (23.7%), Texas (13.0%), New York (8.5%), and Florida (6.3%).
  • In 2018, the most recent data available, 542 deaths in the United States were attributed to TB. This is an increase from 515 deaths attributed to TB in 2017.

In 2019, a total of 71.4% of reported TB cases in the United States occurred among people born outside the United States.

Demographic characteristics of persons with TB remain similar to previous years, with the majority of reported TB cases occurring among non-U.S.–born persons (6,364 cases; 71.4%). A disproportionate number of U.S. TB cases continue to occur in people born outside of the United States, largely because of progression of latent TB infection probably acquired before arriving in the United States.

  • Between 1993 and 2019, cases of TB have declined by 85.4% (to 2,541 cases) among U.S.-born persons and by 14.0% (to 6,364 cases) among non-U.S.–born persons.
  • The most common countries of birth among non-U.S.–born persons with TB in 2019 remained similar to previous years and included Mexico (18.6%), the Philippines (12.5%), India (9.1%), Vietnam (7.9%), and China (6.1%).

In 2019, about 88% of the TB cases reported in the United States occurred among racial and ethnic minority groups.

The distribution of race/ethnicity among persons with TB has been stable since 2010. Racial and ethnic minority groups continue to be disproportionately affected by TB disease.

  • In 2019, Asian persons continued to represent the largest proportion of persons with TB (35.3%), followed by Hispanic persons (30.2%), Black/African American persons (19.7%), and White persons (11.4%).
  • In 2019, despite a downward trend of incidence rates among Native Hawaiian/other Pacific Islander persons (17.6 cases per 100,000 persons) and Asian persons (16.7 cases per 100,000), they remained high compared to other racial/ethnic groups.
  • Incidence rates among American Indian/Alaska Native persons (3.4 cases per 100,000) also declined in 2019 compared with 2018.

The percentage of TB cases that are drug-resistant has remained stable for the last 20 years.

TB bacteria may become resistant to the drugs used to treat TB. This is called drug-resistant TB and means that the drug can no longer kill the bacteria.

  • In 2019, the most common form of primary drug resistance was to isoniazid (INH). INH resistance occurred in 631 cases (approximately 9% of cases with drug susceptibility results).
  • Multidrug-resistant TB (MDR TB) is resistant to at least isoniazid (INH) and rifampin (RIF). There were 90 MDR TB cases (approximately 1% of cases with drug susceptibility results) in 2019.
  • Extensively drug-resistant TB (XDR TB), a type of MDR TB, is resistant to INH and RIF, any fluoroquinolone, and at least one of the injectable second-line anti-TB drugs. There were four cases of XDR TB in the United States in 2019.

It is critical to target prevention and control efforts to certain populations at risk, and further reduce TB rates both in the United States and worldwide.

Of persons diagnosed with TB in 2019:

  • 71.4% were reported among non-U.S.–born persons
  • 20.7% reported having diabetes
  • 8.1% reported excessive alcohol use
  • 4.7% were co-infected with HIV
  • 7.5% reported using noninjectable drugs, and 1.2% reported using injectable drugs
  • 4.6% reported experiencing homelessness in the past year
  • 3.1% were residents of correctional settings at time of diagnosis

Additional Resources
Page last reviewed: October 29, 2020
Content source: Division of Tuberculosis Elimination