Tuberculosis in the inner city: Impact of a continuing epidemic in the 1990s

Tuberculosis cases have recently declined in the United States, renewing in terest in disease elimination. We examined the epidemiology of tuberculosis from 1991 through 1997 at an inner-city public hospital and assessed popul ation-based tuberculosis rates by ZIP code in the 8 metropolitan Atlanta co unties. During the 7 years, 1378 new patients had tuberculosis diagnosed at our hospital (mean, 197 patients/year), accounting for 25% of tuberculosis cases in Georgia. Coinfection with human immunodeficiency virus (HIV) was common, but a significant decrease in the proportion of HIV-infected patien ts with tuberculosis was noted over time. Most patients were members of a m inority group (93%) and were born in the United States (96%), Two inner-cit y ZIP code areas had annual tuberculosis rates >120 cases per 100,000 perso ns, and 8 ZIP code areas had annual rates of 47-88 cases per 100,000 person s between 1993 and 1997, compared with the annual national average of 8.7 c ases per 100,000 persons. Our hospital continues to care for large numbers of tuberculosis patients, and rates of tuberculosis remain high in the inne r city. These data mandate a concentration of efforts and resources in urba n locations if tuberculosis control and elimination is to be achieved in th e United States.