Variation by Race and Ethnicity in the Population Attributable Fractions Associated With Key Tuberculosis Risk Factors in the United States.

OBJECTIVE

Although the overall incidence of tuberculosis (TB) in the United States has declined in the last 2 decades, the incidence among racial and ethnic minority populations remains elevated. The objective of this study was to estimate the contributions of 4 risk factors to the incidence of TB, stratified by race and ethnicity and recent transmission in the United States.

METHODS

We estimated the population attributable fractions (PAFs) of TB and TB attributed to recent transmission (RT-TB) associated with HIV, diabetes, current incarceration, and past-year experience of homelessness in the United States during 2011-2015 and 2016-2019, stratified by race and ethnicity.

RESULTS

The 4 risk factors contributed modestly to TB and RT-TB in the overall US population. During 2016-2019, the estimated PAFs for HIV were 5.0% of all TB cases (6.0% among RT-TB), 6.7% (6.0% among RT-TB) for diabetes, 2.8% (3.9% among RT-TB) for incarceration, and 4.1% (11.3% among RT-TB) for homelessness but varied substantially by race and ethnicity. Diabetes-associated PAFs for RT-TB were >10% among Asian, Hispanic, and Native Hawaiian or Other Pacific Islander populations but 0% among other populations. By contrast, PAFs for RT-TB associated with homelessness were <2% among Asian and Native Hawaiian or Other Pacific Islander populations but >10% among Hispanic, Black, American Indian or Alaska Native, and White populations.

CONCLUSIONS

Efforts to reduce TB disparities in the United States should consider race and ethnicity and associated context.