EPIDEMIOLOGY OF TUBERCULOSIS IN THE UNITED-STATES, 1985 THROUGH 1992

Objective.-To examine the distribution and sources of increased tuberc ulosis (TB) morbidity in the United States from 1985 through 1992. Des ign.-Review of TB surveillance data. Participants.-All incident TB cas es in the United States reported to the Centers for Disease Control an d Prevention from 1980 through 1992. Main Outcome Measures.-Changes in reported number of TB cases from 1985 through 1992 were analyzed by s ex, race/ethnicity, age, country of birth (1986 through 1992), site of disease, geographic location; and socioeconomic status (through 1991) . From 1985 through 1992, reported number of cases was compared with e xpected number of cases, extrapolated from 1980 through 1984 trends, t o estimate excess cases by sex, race/ethnicity, and age. Results.-Incr eases in number of cases from 1985 through 1992 were concentrated amon g racial/ethnic minorities, persons 25 to 44 years of age, males, and the foreign-born. Excess cases occurred in both sexes, all racial/ethn ic groups, and all age groups. Foreign-born cases accounted for 60% of the total increase in the number of US cases from 1986 through 1992 a nd had the greatest impact among Asians, Hispanics, females, and perso ns other than those 25 to 44 years of age. Human immunodeficiency viru s infection had the greatest impact on TB morbidity among whites, blac ks, males, and persons 25 to 44 years of age. From 1985 through 1992, the number of cases among children 4 years old or younger increased 36 %, suggesting that transmission of TB increased during this period.Con clusions.-Multiple factors contributed to the recent increases in the number of TB cases. The effectiveness of TB screening in immigrants ne eds further evaluation. Intensified efforts to determine the human imm unodeficiency virus status of persons with TB are needed. Screening of subpopulations at increased risk for tuberculous infection or TB shou ld be expanded.