Epidemiological Changes in Tuberculosis in Tennessee: Effect of the Acquired Immune Deficiency Syndrome ERA

Document Type

Article

Publication Date

10-1-1996

Description

Purpose: To study changes in the demographics of tuberculosis (TB) in Tennessee. To evaluate the impact of acquired immune deficiency syndrome (AIDS) on epidemiological changes in tuberculosis in Tennessee. Methods: We conducted statistical analysis and review of epidemiological data from the reported TB cases in Tennessee for the period 1990-1994. All cases met the Centers for Disease Control (Atlanta, Georgia) criteria for diagnosis of TB. Variables including age, sex, race, site of disease, ana high risk factors (human immunodeficiency virus infection, homelessness, long-term care facility residence, and prisoner status) were examined. Results: Of the 2773 reported cases, 1778 were male; 995 were female. During the study period the incidence of TB declined from 11.8 per 100,000 in 1990 to 10.4 in 1994. When divided by age groups, the percentage of those aged 65 years and older dropped from 48.7% in 1990 to 40.1% in 1994 (p = 0.004). This decline was predominantly among non-whites and males. Extrapulmonary TB increased from 16.2% of the total cases in 1990 to 17.1% in 1994 (p = 0.678) (Table). High risk groups comprised a large percentage of TB cases; significant increases were evidenced in the homeless (p < 0.00001), prisoners (p = 0.041), and in HIV-infected persons (p = 0.0001), but not in nursing home residents (p = 0.738). A several-fold higher rate of TB continued to be seen in non-whites compared to whites regardless of age. Tuberculosis case rates were statistically higher in urban counties than in rural. Conclusions: While TB is declining in Tennessee, epidemiology of the disease is changing in such a way that impact of the AIDS epidemic is appreciably greater than before. This late effect of shifting demographics in Tennessee was associated with an increase in the number of AIDS cases with concomitant TB. Clinical Implications: While the statewide incidence of TB continues to decline, pockets of high risk TB groups do persist. The growing percentage of extrapulmonary TB and its association with socio-economic hardship pose a formidable challenge in TB control/eradication. Year 1990 1991 1992 1993 1994 Incidence 11.8 11.3 10.7 11.2 10.4 Total Cases 598 574 527 555 519 % Extrapul. 16.2 15.2 17.3 14.6 17.1 % Age ≥ 65 48.7 47.6 46.7 41.8 40.1 % High Risk 11.0 14.3 10.1 19.3 24.3.

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