Prevalence of Tuberculosis Infection in the United States Population: The National Health and Nutrition Examination Survey, 1999-2000

• Published in: American journal of respiratory and critical care medicine Vol. 177; no. 3; pp. 348 - 355
• Main Authors: Bennett, Diane E, Courval, Jeanne M, Onorato, Ida, Agerton, Tracy, Gibson, Judy D, Lambert, Lauren, McQuillan, Geraldine M, Lewis, Brenda, Navin, Thomas R, Castro, Kenneth G
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 01-02-2008; American Lung Association; American Thoracic Society
• Subjects: Adolescent; Adult; African Americans; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Estimates; Ethnicity; Female; Hispanic Americans; Humans; Infant; Infections; Intensive care medicine; Male; Medical sciences; Middle Aged; Mycobacterium; Nutrition; Nutrition Surveys; Population; Poverty; Prevalence; Tuberculin Test; Tuberculosis; Tuberculosis - epidemiology; Tuberculosis - ethnology; United States - epidemiology; United States; North America; America; United States > US; Infection; Intensive care; tuberculosis infection; Prevalence; Tuberculosis; United States; Bacteriosis; tuberculin test; Mycobacterial infection; Tuberculin; Epidemiology; Resuscitation
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200701-057OC

The goal for tuberculosis (TB) elimination in the United States is a TB disease incidence of less than 1 per million U.S. population by 2010, which requires that the latent TB infection (LTBI) prevalence be less than 1% and decreasing.
To estimate the prevalence of LTBI in the U.S. population.
Interviews and medical examinations, including tuberculin skin testing (TST), of 7,386 individuals were conducted in 1999-2000 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the civilian, noninstitutionalized U.S. population. LTBI was defined as a TST measurement of >/=10 mm. Associations of age, race/ethnicity, sex, poverty, and birthplace were assessed. Results among the 24- to 74-year-old subgroup were compared with NHANES 1971-1972 data.
Estimated LTBI prevalence was 4.2%; an estimated 11,213,000 individuals had LTBI. Among 25- to 74-year-olds, prevalence decreased from 14.3% in 1971-1972 to 5.7% in 1999-2000. Higher prevalences were seen in the foreign born (18.7%), non-Hispanic blacks/African Americans (7.0%), Mexican Americans (9.4%), and individuals living in poverty (6.1%). A total of 63% of LTBI was among the foreign born. Among the U.S. born, after adjusting for confounding factors, LTBI was associated with non-Hispanic African-American race/ethnicity, Mexican American ethnicity, and poverty. A total of 25.5% of persons with LTBI had been previously diagnosed as having LTBI or TB, and only 13.2% had been prescribed treatment.
In addition to basic TB control measures, elimination strategies should include targeted evaluation and treatment of individuals in high-prevalence groups, as well as enhanced support for global TB prevention and control.