Trends in Tuberculosis-Related Mortality in the United States, 1999 to 2022: A Nationwide Analysis based on Sex, Race, Age, Region, & Locality

Background :Tuberculosis (TB) is a significant cause of mortality in the United States (US), impairing individual health and causing national financial burden. Although TB mortality has declined in recent years, drug resistance and comorbid conditions make TB difficult to prevent, necessitating further analysis of which demographic groups are most impacted by TB. Methods : Mortality trends due to TB in individuals aged 35 to 85+ years in the US from 1999 to 2022 were analyzed utilizing the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Following data collection, age-adjusted mortality rate (AAMR) and average annual percent change (AAPC) in TB-related mortality were examined. Data was further stratified by sex, race, age, region, and locality. Results : Between 1999 and 2022, there were 26,600 deaths related to TB in the US. Overall TB mortality declined between 1999 and 2022 (AAPC, -3.95%*). Males had consistently higher AAMR than females, with 16,741 deaths among males and 9,859 deaths among females. All racial groups, including Asian or Pacific Islander, Black or African American, White, and Hispanic or Latino individuals experienced declines in mortality (AAPC, -3.24%*, -5.75%*, -3.83%*, -4.70%*, respectively). Asian or Pacific Islander, Black or African American, and Hispanic or Latino populations had consistently higher AAMR than White patients between 1999 and 2022, however. Individuals older than 65 experienced significantly higher AAMR than younger individuals. South and West regions had higher AAMR than Northeast and Midwest regions, with the West and South experiencing the smallest and largest declines in mortality, respectively (AAPC, -3.04%*; AAPC, -4.66%*). TB-related mortality was higher in urban areas, with 20,680 deaths compared to 3,707 deaths in rural areas. Conclusion : Overall decline in nationwide TB-related mortality is not experienced equally by all groups, with male sex, race, older age, region, and locality possibly increasing risk.