Tuberculosis trends in California correctional facilities, 1993-2013.

BACKGROUND

Incarcerated persons are disproportionately diagnosed with tuberculosis (TB). California has the second highest inmate population in the United States, but reports the highest number of cases.

OBJECTIVE

To describe the TB epidemiology among incarcerated patients in California.

METHODS

Trends in incidence were assessed using Poisson regression, and trends in percentage were assessed using weighted linear regression. Demographic and clinical characteristics were compared using χ2 or Mann-Whitney U tests.

RESULTS

During 1993-2013, of the 64 090 TB cases reported, 2323 (4%) were correctional facility residents. Incidence in correctional facilities decreased until 2006 (annual per cent change [APC] -12.3%, 95%CI -14.4 to -10.1), but has since stabilized (APC 4.4%, 95%CI -2.1 to 11.4). Compared with state prisoners, federal prisoners were more likely to be male (98%, P = 0.03), persons arriving in the United States within 5 years of diagnosis (62%, P < 0.001), and born in Mexico (88%, P = 0.02), whereas local jail inmates were more likely to have a history of substance use (75%, P < 0.001) and homelessness (35%, P < 0.001).

CONCLUSIONS

TB incidence in correctional facilities had steadily declined over the last two decades, but has recently leveled out. To promote further reduction in incidence among diverse incarcerated populations, health departments and correctional facilities should strengthen collaboration by conducting TB risk-based assessments.