Tuberculosis trends in California correctional facilities, 1993-2013

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.

To describe the TB epidemiology among incarcerated patients in California.

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.

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).

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.