Adada H, Valley M A, Nour S A, Mehta J, Byrd R P, Anderson J L, Roy T
Department of Pulmonary and Critical Care Medicine, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.
Department Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.
Int J Tuberc Lung Dis. 2014 Dec;18(12):1516-21. doi: 10.5588/ijtld.14.0319.
The incidence of tuberculosis (TB) in the United States has declined following a logarithmic pattern, with few exceptions. One exception was during the acquired immunodeficiency syndrome (AIDS) epidemic, which was thought to have caused the deviation. However, since then, alternative explanations have been proposed, including the increased burden of chronic diseases, immigration, and the increase in the use of immune suppressant medications.
Epidemiological data of the Center for Disease Control and Prevention (CDC) and the Bureau of the Census were analyzed regarding TB incidence, human immunodeficiency virus (HIV) infection, immigration status, and age for the period 1953-2011.
Data analysis identified a deviation from the logarithmic decline in TB cases that started in the mid-2000s. This divergence did not appear to be related to HIV status. The overall decline in TB cases since 1953 has been almost exclusively due to a reduction in pulmonary TB (PTB) and not to extra-pulmonary TB (EPTB).
The HIV/AIDS epidemic likely played a significant role in the 1979-1985 deviation, but not subsequently. Furthermore, EPTB as a proportion of total TB cases has remained high. Further studies to delineate the etiologies of these findings are needed.
美国结核病（TB）发病率呈对数下降趋势，仅有少数例外情况。其中一个例外是在获得性免疫缺陷综合征（AIDS）流行期间，人们认为这导致了偏差。然而，自那时以来，人们提出了其他解释，包括慢性病负担增加、移民以及免疫抑制药物使用增加。
分析了疾病控制与预防中心（CDC）和人口普查局1953 - 2011年期间关于结核病发病率、人类免疫缺陷病毒（HIV）感染、移民状况和年龄的流行病学数据。
数据分析发现，自21世纪中叶开始，结核病病例数偏离了对数下降趋势。这种偏差似乎与HIV感染状况无关。自1953年以来，结核病病例数的总体下降几乎完全归因于肺结核（PTB）的减少，而非肺外结核（EPTB）。
HIV/AIDS流行可能在1979 - 1985年的偏差中起了重要作用，但之后并非如此。此外，EPTB占结核病总病例数的比例一直居高不下。需要进一步研究以阐明这些发现背后的病因。
