I work in a large university hospital that provides care to the urban poor. Tuberculosis is frequently on the differential diagnosis and we commonly treat active tuberculosis every year. This recent review on the epidemiology of Tuberculosis in the USA, published in the American Journal of Public Health, is eye opening.
Several points are noteworthy. The authors found 42,448 patients with TB in 48 cities accounted for 36% of all US patients with TB. These cities comprised 15% of the US population. In these cities, the TB incidence rate in (12.1 per 100,000) was higher than that in the US excluding the cities (3.8 per 100,000). Nineteen cities had decreasing rates; 29 cities had nondecreasing rates. There were no consistent patient variables to predict cities with decreasing or nondecreasing TB rates.
A significant TB burden still occurs in large US cities and more than half (60%) of the cities studied did not show decreasing TB incidence rates.
It seems like we have much to learn about factors impacting TB control in US cities, including city-level variations in migration, socioeconomic status, and resource allocation.
