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Tuberculosis in Children, Adolescents, and Young Adults in California, 2000-2023
Kristen A Wendorf1, Amalya Penso1,2, Merrera S Kebeba1,2
1California Department of Public Health, TB Control Branch, Richmond, California.
Insights
Pediatric tuberculosis (TB) rates declined in California, but significant disparities persist among young people based on age, race, and neighborhood. Central nervous system TB incidence remains high, requiring improved public health and primary care collaboration.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Pediatric tuberculosis (TB) remains a global health concern, with varying incidence and disparities across populations.
- Understanding trends in pediatric TB is crucial for targeted interventions and effective public health strategies.
Purpose of the Study:
- To analyze trends in pediatric tuberculosis epidemiology in California from 2000 to 2023.
- To identify and measure health disparities in pediatric TB incidence across different demographic and geographic factors.
- To assess progress in reducing TB health disparities among individuals under 25 years old.
Main Methods:
- Analysis of demographic, clinical, and neighborhood health support data for individuals under 25 years with TB in California (2000-2023).
- Stratification of data by age groups to identify specific trends and disparities.
- Comparison of TB incidence rates across racial/ethnic groups, geographic regions, and neighborhood health support levels.
Main Results:
- A total of 8,249 individuals under 25 years were diagnosed with active TB; 45.8% were US-born.
- Highest incidence rates were observed among Asians, San Diego region residents, and those in least health-supportive neighborhoods.
- Significant racial/ethnic disparities were noted, with Asian, Hispanic, and Black individuals having substantially higher TB rates compared to White individuals. Central nervous system (CNS) TB incidence did not decrease and had a higher mortality rate. US-born individuals under 18 had a higher incidence of CNS TB.
Conclusions:
- Despite an overall decline in pediatric TB rates in California, significant disparities persist based on age, race/ethnicity, region, and neighborhood health support.
- The incidence of central nervous system (CNS) TB has not declined, indicating a critical area for intervention.
- Enhanced collaboration between public health agencies and primary care providers is essential to identify and manage at-risk children and young adults for TB.
Objectives:
To identify trends in pediatric tuberculosis (TB) epidemiology in California and measure progress in reducing health disparities.
Methods:
Demographic, clinical, and neighborhood health support data in persons younger than 25 years with TB during 2000-2023 in California were analyzed across age groups.
Results:
A total of 8249 individuals younger than 25 years were identified with active TB. Half (45.8%) were US-born. Incidence rates were highest among Asians, residents of the San Diego region, and those living in the least-health-supportive neighborhoods. The highest TB rates occurred among 18- to 24-year-olds in 6 regions and among children younger than 5 years in 2 regions. TB rates declined across the period; 2 regions had rate increases during 2020-2023. During 2020-2023, compared with white persons, the rate of TB disease was 20.2 (95% CI, 13.2-29.4) times higher among Asian, 10.8 (95% CI, 7.1-15.4) among Hispanic, and 8.5 (95% CI, 5.1-13.4) among Black persons. Central nervous system (CNS) TB did not decrease; deaths among individuals with CNS TB were 9.5 times greater (95% CI, 5.6-16.2) than among those with other forms of TB. After controlling for age, the incidence rate of CNS TB in US-born individuals was 2.9 (95% CI, 1.9-4.7) times that for non-US-born individuals younger than 18 years.
Conclusions:
Despite falling TB rates among persons younger than 25 years in California, disparities were found by age, race and ethnicity, region, and health-supportiveness of neighborhood type. The incidence of CNS TB has not declined. Increased partnership between public health and primary care providers is needed to identify children and young adults at risk for TB.
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