CDC issues report on the top ten states with the highest rates of TB

The number of new tuberculosis (TB) cases reported in the United States declined by seven percent from 1999 to 2000, continuing an eight-year downward trend since the TB epidemic peaked in 1992, according to final data released today by the Centers for Disease Control and Prevention (CDC).

A total of 16,377 TB cases were reported from the 50 states and the District of Columbia in 2000, an all-time low, down from 17,531 cases in 1999. Since the 1992 peak, the rate of TB cases has dropped 45 percent, from 10.5 cases per 100,000 people in 1992 to 5.8 cases per 100,000 in 2000. CDC released the new data in preparation for the National TB Controllers Workshop 2001, a meeting where state and city public health officials discuss how to prevent future cases of TB. The meeting will be held in Baltimore from June 18 to 21, 2001.

"While the 2000 national TB figures highlight the effectiveness of U.S. TB control efforts, the disease still remains a significant health threat in many parts of this country," said Jeffrey P. Koplan, M.D., M.P.H., director of CDC. "To eliminate TB as a public health problem in the United States, efforts will need to be accelerated in those states and communities most affected by the disease."

Top ten states with the highest TB rates

CDC also released data on the ten states with the highest TB rates – the number of TB cases per 100,000 people – pointing to several areas where prevention and control efforts must be accelerated.

The ten states that led the nation with the highest TB rates in 2000 were (in ranking order) Alaska, Hawaii, California, New York, Georgia, Arkansas, Louisiana, Florida, Texas, and South Carolina. (See the table below for a complete listing of TB cases and rates by state.)

Seven of the top ten states had a decrease in TB rates between 1999 and 2000, but three states – Alaska, Arkansas and Georgia – reported increases in rates.

Alaska had the most dramatic rise in rates from 9.9 in 1999 to 17.2 in 2000. TB rates in Arkansas climbed from 7.1 to 7.4 and the rates in Georgia increased slightly from 8.5 to 8.6.

Historically, U.S. TB rates declined steadily from 1953 until 1985, when cases began to increase following a sharp cut in TB control resources in the 1970s and the spread of HIV/AIDS in the 1980s. TB cases increased by 20 percent from 1985 to 1992, a climb that was reversed with the strengthening of TB control activities, including screening and treatment, in 1992. In contrast to the downward trends in the United States since 1992, TB continues unabated globally with 8 million new TB cases each year and 2 million deaths attributed to TB.

"The growing global TB epidemic could impact the declines made in the United States, if TB defense systems are not maintained," said Helene Gayle, M.D., M.P.H., director of CDC's National Center for HIV, STD, and TB Prevention. "Innovative approaches and support, as well as a commitment to global TB control, will be required to eliminate this disease from the United States."

CDC protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

  Cases

Case Rates

Rank According to Rate

State

2000

1999

2000

1999

2000

1999

U.S.

16,377

17,531

5.8

6.4

—

—

Alaska

108

61

17.2

9.8

1

4

Hawaii

136

184

11.2

15.5

2

1

California

3,297

3,606

9.7

10.9

3

2

New York

1,744

1,837

9.2

10.1

4

3

Georgia

703

665

8.6

8.5

5

5

Arkansas

199

181

7.4

7.1

6

12

Louisiana

331

357

7.4

8.2

7

8

Florida

1,171

1,277

7.3

8.5

8

6

Texas

1,506

1,649

7.2

8.2

9

7

South Carolina

286

315

7.1

8.1

10

9

Alabama

310

314

7.0

7.2

11

11

Tennessee

383

382

6.7

7.0

12

14

New Jersey

565

571

6.7

7.0

13

13

Mississippi

173

215

6.1

7.8

14

10

Illinois

743

825

6.0

6.8

15

15

North Carolina

447

488

5.6

6.4

16

16

Maryland

282

294

5.3

5.7

17

18

Arizona

261

262

5.1

5.5

18

19

Nevada

96

93

4.8

5.1

19

22

Rhode Island

49

53

4.7

5.3

20

20

Massachusetts

285

270

4.5

4.4

21

26

Oklahoma

154

208

4.5

6.2

22

17

Washington

258

258

4.4

4.5

23

25

Virginia

292

334

4.1

4.9

24

23

Missouri

211

208

3.8

3.8

25

28

Kentucky

147

209

3.6

5.3

26

21

Minnesota

178

201

3.6

4.2

27

27

Delaware

28

34

3.6

4.5

28

24

Oregon

119

123

3.5

3.7

29

30

Pennsylvania

383

454

3.1

3.8

30

29

Connecticut

105

121

3.1

3.7

31

31

Ohio

340

317

3.0

2.8

32

35

Michigan

287

351

2.9

3.6

33

33

Kansas

77

69

2.9

2.6

34

36

New Mexico

46

64

2.5

3.7

35

32

Indiana

145

150

2.4

2.5

36

37

Montana

21

14

2.3

1.6

37

44

Colorado

97

88

2.3

2.2

38

39

Utah

49

40

2.2

1.9

39

42

South Dakota

16

21

2.1

2.9

40

34

Maine

24

23

1.9

1.8

41

43

West Virginia

33

41

1.8

2.3

42

38

New Hampshire

22

19

1.8

1.6

43

45

Wisconsin

92

110

1.7

2.1

44

40

Nebraska

24

18

1.4

1.1

45

48

Iowa

40

58

1.4

2.0

46

41

Idaho

16

16

1.2

1.3

47

46

Wyoming

4

3

0.8

0.6

48

49

North Dakota

5

7

0.8

1.1

49

47

Vermont

4

3

0.7

0.5

50

50

District of Columbia*

85

70

14.9

13.5

—

—

*Not ranked with the states.

Note: Denominators for computing 2000 rates for the states and the District of Columbia were obtained from the U.S. Census Bureau.

Source: National Tuberculosis Surveillance System, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention. Date: June 1, 2001.