TRENDS IN DEATH WITH TUBERCULOSIS DURING THE AIDS ERA

Objective.-To describe and analyze recent changes in tuberculosis mort ality in the United States during the acquired immunodeficiency syndro me (AIDS) epidemic. Design.-We used National Center for Health Statist ics multiple-cause mortality data and analyzed deaths with tuberculosi s (1980 through 1990) and/or AIDS (1987 through 1990) as an underlying or associated cause. We also categorized the 50 states and the Distri ct of Columbia into high (five states), medium (23 states), and low (2 3 states) AIDS incidence groups and then compared the groups' rates of death with tuberculosis during the period 1980 through 1990. Study Po pulation.-Residents of the United States who died in the period 1980 t hrough 1990. Main Outcome Measures.-Death certificates indicating AIDS and/or tuberculosis.Results.-A bimodal age distribution of persons dy ing with tuberculosis has emerged concurrent with the AIDS epidemic. A new peak spanning the ages 20 to 49 years accompanies the preexisting peak in the elderly. In 1990, 54.2% (729/1344) of the deaths with tub erculosis in persons 20 to 49 years of age occurred in persons who als o had AIDS listed on their death certificates. During the period 1987 through 1990, there was an increasing trend in the proportion of AIDS deaths that also had tuberculosis: 2.3% (353/15 075) in 1987, 2.5% (46 0/18 649) in 1988, 3.0% (738/24 607) in 1989, and 3.0% (836/27 975) in 1990 (P<.001). Of AIDS deaths in 1990, 1.6% (253/15 565) of whites di ed with tuberculosis, compared with 4.7% (400/8533) of blacks (P<.001) and 4.7% (172/3666) of Hispanics (P<.001). In the high AIDS incidence states, the rate of death with tuberculosis in persons aged 20 to 49 years rose from 0.61 to 2.82 per 100 000 population in the period 1982 through 1990, an increase of 362%. For this age group in the states w ith medium and low AIDS incidence, the rates of death with tuberculosi s during this period rose 52% and 47% (from 0.44 to 0.67 and from 0.19 to 0.28 per 100 000 population), respectively. The increases in the r ate of death with tuberculosis within all three groups and the differe nces among the groups were all highly statistically significant (P<.00 1). Conclusion.-The AIDS epidemic has significantly increased the numb er and rate of tuberculosis deaths in younger adults through 1990, alt hough in this study discrimination of deaths due to tuberculosis from deaths with tuberculosis was not possible. Vigorous efforts to prevent and treat tuberculosis and AIDS are indicated to reverse the trends w e have described.