Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Y.L., M.R., N.A.S.).
Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (T.B., R.L.M.).
Ann Intern Med. 2024 Apr;177(4):418-427. doi: 10.7326/M23-2975. Epub 2024 Apr 2.
Elevated tuberculosis (TB) incidence rates have recently been reported for racial/ethnic minority populations in the United States. Tracking such disparities is important for assessing progress toward national health equity goals and implementing change.
To quantify trends in racial/ethnic disparities in TB incidence among U.S.-born persons.
Time-series analysis of national TB registry data for 2011 to 2021.
United States.
U.S.-born persons stratified by race/ethnicity.
TB incidence rates, incidence rate differences, and incidence rate ratios compared with non-Hispanic White persons; excess TB cases (calculated from incidence rate differences); and the index of disparity. Analyses were stratified by sex and by attribution of TB disease to recent transmission and were adjusted for age, year, and state of residence.
In analyses of TB incidence rates for each racial/ethnic population compared with non-Hispanic White persons, incidence rate ratios were as high as 14.2 (95% CI, 13.0 to 15.5) among American Indian or Alaska Native (AI/AN) females. Relative disparities were greater for females, younger persons, and TB attributed to recent transmission. Absolute disparities were greater for males. Excess TB cases in 2011 to 2021 represented 69% (CI, 66% to 71%) and 62% (CI, 60% to 64%) of total cases for females and males, respectively. No evidence was found to indicate that incidence rate ratios decreased over time, and most relative disparity measures showed small, statistically nonsignificant increases.
Analyses assumed complete TB case diagnosis and self-report of race/ethnicity and were not adjusted for medical comorbidities or social determinants of health.
There are persistent disparities in TB incidence by race/ethnicity. Relative disparities were greater for AI/AN persons, females, and younger persons, and absolute disparities were greater for males. Eliminating these disparities could reduce overall TB incidence by more than 60% among the U.S.-born population.
Centers for Disease Control and Prevention.
最近，美国的少数族裔人群结核病（TB）发病率有所上升。跟踪这些差异对于评估实现国家健康公平目标的进展情况以及实施变革非常重要。
量化美国出生人群中 TB 发病率的种族/民族差异趋势。
对 2011 年至 2021 年全国 TB 登记数据进行时间序列分析。
美国。
按种族/族裔分层的美国出生人群。
与非西班牙裔白人相比的 TB 发病率、发病率差异和发病率比；（从发病率差异计算得出）额外的 TB 病例；以及差异指数。分析按性别和归因于近期传播的 TB 疾病进行分层，并按年龄、年份和居住地进行调整。
在分析每个种族/族裔群体与非西班牙裔白人相比的 TB 发病率时，印第安裔或阿拉斯加原住民（AI/AN）女性的发病率比高达 14.2（95%CI，13.0 至 15.5）。对于女性、年轻人群和归因于近期传播的 TB，相对差异更大。对于男性，绝对差异更大。2011 年至 2021 年期间，额外的 TB 病例分别占女性和男性总病例的 69%（CI，66%至 71%）和 62%（CI，60%至 64%）。没有证据表明发病率比随时间下降，并且大多数相对差异指标显示出较小的、统计学上不显著的增加。
分析假设 TB 病例的诊断和种族/民族自我报告是完整的，并且没有调整医疗合并症或健康的社会决定因素。
TB 发病率存在持续的种族/民族差异。对于 AI/AN 人群、女性和年轻人群，相对差异更大，对于男性，绝对差异更大。消除这些差异可以使美国出生人群的总体 TB 发病率降低 60%以上。
疾病控制与预防中心。
