Tuberculosis in Indigenous Persons - United States, 2009-2019

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease

Background:

• Indigenous populations in the U.S. experience disproportionately high rates of tuberculosis (TB) compared to non-indigenous groups.
• Significant health disparities persist for TB among U.S. indigenous persons.

Purpose of the Study:

• To compare the incidence rates and risk factors of TB among American Indian or Alaska Native (AIAN) and Native Hawaiian or other Pacific Islander (NHPI) TB patients to White TB patients in the U.S.
• To identify specific risk factors contributing to TB disparities in indigenous populations.

Main Methods:

• Utilized data from the National Tuberculosis Surveillance System for U.S.-born patients from 2009-2019.
• Calculated incidence rate ratios and risk ratios to compare TB risk factors between AIAN, NHPI, and White patient groups.
• Analyzed comorbidities such as renal disease, diabetes, and HIV status, alongside social determinants like homelessness and alcohol use.

Main Results:

• Annual TB incidence rates were at least 10 times higher in AIAN and NHPI populations compared to White individuals.
• AIAN and NHPI patients showed increased likelihood of renal disease (1.91x and 3.39x) and diabetes (1.33x and 1.63x) compared to White patients.
• AIAN patients reported higher rates of excess alcohol use (1.84x) and homelessness (1.48x), while both AIAN and NHPI groups were less likely to be HIV positive.

Conclusions:

• Tuberculosis among U.S. indigenous persons is linked to ongoing and significant health disparities.
• Addressing comorbidities and social determinants of health is crucial for mitigating TB disparities in AIAN and NHPI communities.