Tuberculosis Trends, Disparities, and Forecasts in the United States: Will the 2035 Elimination Goal Be Met?

Background Tuberculosis (TB) remains a US public health concern, with persistent disparities, yet TB-related mortality trends, especially among older adults, remain understudied. Methods This cross-sectional study analysed CDC-WONDER mortality data (1999–2023) and National Notifiable Diseases Surveillance System incidence data (1999–2022) for adults aged ≥ 45 years. TB (ICD-10: A16-A19) incidence rates (IRs), age-adjusted and crude mortality rates (AAMRs, CMRs) were calculated per million population. Trends were analysed using Joinpoint regression, and ARIMA models were used to forecast mortality through 2035 in the context of the US elimination target. Results From 1999–2022, TB IRs declined from 64.3 to 25.0 per million. AAMRs fell from 17.4 to 7.5 between 1999–2023 (AAPC = -3.36%, 95% CI: -3.72 to -2.98). Of 26,341 deaths, 62.5% were male. By 2023, AAMRs in both genders had declined by over half. CMRs decreased across all age groups, with the largest decline in those ≥ 85 years, who also had the highest rates. Asian/Pacific Islander and American Indian/Alaska Native populations consistently had the highest AAMRs, while White individuals had the lowest. All regions except the West showed steady declines. Alaska, Hawaii, California, Mississippi, and Texas had the highest AAMRs. Large metropolitan areas consistently had higher AAMRs. Most deaths were due to respiratory TB, and 65.2% occurred in inpatient hospitals. Forecasting indicated that AAMRs are projected to remain above the US elimination threshold by 2035. Conclusion TB-related mortality in the US has declined over two decades, but recent resurgence and persistent demographic and geographic disparities highlight the need for targeted interventions to achieve elimination.