Health Disparities in Tuberculosis

What is a health disparity?

Despite prevention efforts, TB affects some groups of people more than others.

A health disparity is the occurrence of diseases at greater levels among certain population groups more than among others. Differences in rates of diseases, like TB, may occur by race or ethnicity, health conditions, and geographic location.

Social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. Social determinants of health like poverty, unequal access to health care, lack of education, stigma, and racism are linked to health disparities. For example, stigma around TB may deter people from seeking medical care or follow-up care if they are sick.

Health disparities

Some population groups have higher rates of TB disease in their communities. These groups are at higher risk of being exposed to TB germs.

Additionally, a range of social, economic, and demographic factors affect a person’s risk for TB disease.

Racial and ethnic disparities

In 2022, 88.4% of the TB cases reported in the United States occurred among racial and ethnic minority groups.

In the United States, TB affects some racial and ethnic minority groups more than others, including:

• Asian persons
• Black or African American persons
• Hispanic or Latino persons

Medicines or health conditions

Certain medicines or health conditions contribute to disparities in the rate of TB. Health conditions such as diabetes, cancer, or HIV infection weaken the body's immune system. A weakened immune system lowers a person's ability to fight TB germs. As a result, people with these health conditions are more likely to develop TB disease if they are infected with TB germs.

Geographic disparities

United States

TB disease rates vary across the United States. Consistent with previous years, in 2022, four states accounted for half of all reported U.S. TB cases:

• California
• Texas
• New York (including New York City)
• Florida

Around the world

TB disease rates also vary around the world. Because of the substantially greater risk of exposure to TB germs outside of the United States, people who were born in or frequently travel to countries where TB is more common are more likely to be exposed to TB germs. In 2022, the TB incidence rate was 17.1 times higher among non-U.S.–born persons compared with U.S.-born persons.

Other disparities

People experiencing homelessness and people who live or work in correctional facilities are at increased risk for TB.

What prevents health equity

TB is a challenging disease to diagnose, treat, and control. Dwindling resources and loss of public health capacity, including access to care, and maintaining clinical and public health expertise, add to the challenge.

Communities affected by TB disparities face a number of challenges.

Treatment duration and completion

TB treatment takes several months to complete. Some people may not be able to or want to take TB medicines for several months.

People with TB disease who do not take their medicine correctly could:

• Get sick with TB disease again
• Spread TB to others
• Develop drug-resistant TB

People with inactive TB (also called latent TB infection) do not feel sick, do not have symptoms, and cannot spread TB germs to others. It might not be a priority to treat inactive TB since they do not feel sick.

Socioeconomic factors

Socioeconomic factors can directly or indirectly increase a person's risk for TB disease and make treatment difficult. These factors include:

• Poverty,
• Limited access to
  • Quality health care,
  • Employment opportunities,
  • Housing,
  • Transportation, and
• Adverse health outcomes.

Language barriers and cultural factors may also place certain populations at higher risk for TB. These include factors such as:

• Health knowledge,
• Stigma associated with the disease,
• Values, and
• Beliefs.

What CDC is doing

CDC is committed to improving the health of people disproportionately affected by TB by identifying the underlying causes of health disparities in TB and developing strategies to improve health equity.

Partnerships

• Collaborate with other national and international public health organizations to improve TB control and prevention activities among immigrants and refugees.
• Support the TB Elimination Alliance to increase knowledge, testing, and treatment of TB among communities at increased risk.
• Provide assistance through the TB Centers of Excellence for Training, Education, and Medical Consultation, which support TB control and prevention efforts in the United States
• Engage with domestic partners such as, We Are TB, a community of TB survivors, people being treated for TB, and their family members, working together to eliminate TB.

Communication and outreach

• Maintain a Spanish TB website that provides Spanish-language TB information.
• Develop culturally and linguistically appropriate patient education materials, and share through platforms like Find TB Resources.
• Promote the Think. Test. Treat TB. national multilingual communication campaign to reach
  • Those most at risk for inactive TB and
  • Their health care providers to encourage TB testing and treatment.
• Highlight the personal stories of people who were diagnosed and treated for TB, as well as the work of TB control professionals.
• Engage health care providers about the latest TB diagnostics and treatment options available.
• Lead community engagement and outreach to engage communities at risk to raise awareness of TB.

Data

• Compile national reports of TB cases and TB case rates by gender, race and ethnicity, risk factors, and geographic location.
• Continue the work of two CDC research consortiums to
  • Examine more effective TB treatment options and
  • Study the risks for TB among persons with certain medical conditions.

Resources

Materials are available free of charge for order via CDC-Info On Demand Publications (see ordering instructions).