MMWR Recomm Rep. 1992 Apr 17;41(RR-5):1-11.
Tuberculosis (TB) is an increasing public health problem in the United States, particularly among racial/ethnic minorities. In 1990, the number of reported TB cases increased 9.4% compared with 1989 and 15.5% compared with 1984. In 1990, almost 70% of all TB cases and 86% of those among children ages less than 15 years occurred among racial/ethnic minorities. Compared with non-Hispanic whites, the 1990 TB case rate was notably higher for racial/ethnic minorities. Adverse social and economic factors, the human immunodeficiency virus epidemic, and immigration of persons with tuberculous infection are contributing factors to the increase in TB cases. Other contributing factors include physician nonadherence in prescribing recommended treatment regimens and patient nonadherence in following prescribed recommended treatment regimens. To eliminate TB in U.S. communities with at-risk racial/ethnic minorities, the Advisory Council for the Elimination of Tuberculosis recommends a) initiating public awareness campaigns to alert these communities about the increasing TB problems; b) training and educating public and private health-care providers in the skills needed to relate effectively to the at-risk communities being served, and empowering at-risk populations with knowledge and other resources needed to influence the TB programs directed toward their communities; c) building coalitions to help design and implement intensified community TB prevention and control efforts; d) intensifying the screening of at-risk populations for TB and tuberculous infection and providing appropriate treatment and preventive therapy; e) increasing the speed and completeness with which all health-care providers report confirmed and suspected TB cases to appropriate health departments; and f) improving the availability and quality of TB health-care services in socioeconomically disadvantaged areas.
结核病在美国正成为一个日益严重的公共卫生问题，在少数种族/族裔群体中尤为如此。1990年，报告的结核病病例数与1989年相比增加了9.4%，与1984年相比增加了15.5%。1990年，所有结核病病例中近70%以及15岁以下儿童病例中的86%发生在少数种族/族裔群体中。与非西班牙裔白人相比，1990年少数种族/族裔群体的结核病发病率明显更高。不利的社会和经济因素、人类免疫缺陷病毒流行以及结核感染人群的移民是结核病病例增加的促成因素。其他促成因素包括医生在开具有推荐治疗方案时不依从以及患者在遵循规定的推荐治疗方案时不依从。为了在美国有高危少数种族/族裔群体的社区消除结核病，消除结核病咨询委员会建议：a）发起公众意识运动，提醒这些社区注意日益严重的结核病问题；b）培训和教育公共及私人医疗保健提供者，使其掌握与所服务的高危社区有效沟通所需的技能，并使高危人群掌握影响针对其社区的结核病项目所需的知识和其他资源；c）建立联盟，以帮助设计和实施强化的社区结核病预防和控制工作；d）加强对高危人群的结核病和结核感染筛查，并提供适当的治疗和预防性治疗；e）提高所有医疗保健提供者向适当卫生部门报告确诊和疑似结核病病例的速度和完整性；f）提高社会经济弱势地区结核病医疗保健服务的可及性和质量。
