Unexpected decline in tuberculosis cases coincident with economic recession - United States, 2009

Winston, Carla A; Navin, Thomas R; Becerra, Jose E; Chen, Michael P; Armstrong, Lori R; Jeffries, Carla; Yelk Woodruff, Rachel S; Wing, Jessie; Starks, Angela M; Hales, Craig M; Kammerer, J Steve; Mac Kenzie, William R; Mitruka, Kiren; Miner, Mark C; Price, Sandy; Scavotto, Joseph; Cronin, Ann M; Griffin, Phillip; LoBue, Philip A; Castro, Kenneth G

doi:10.1186/1471-2458-11-846

BMC Public Health

Table 1 Observed and expected tuberculosis case counts by select demographic and risk factor characteristics for January-December 2009, United States

From: Unexpected decline in tuberculosis cases coincident with economic recession - United States, 2009

	Observed Case Count	Expected Case Count (95% Prediction Interval)	Case Count Difference*	Percentage of Expected	Pvalue
Total	11545	12539 (12233 - 12853)	-994	-7.9	<.001
Country of origin
Foreign-born	6854	7709 (7318 - 8120)	-855	-11.1	<.001
U.S.-born	4571	4918 (4661 - 5190)	-347	-7.1	.005
Unknown	120	21 (10 - 48)	99	471.4	.020
For foreign-born, length of stay in United States
< 2 years	1432	1872 (1590 - 2204)	-440	-23.5	<.001
> = 2 years	4712	5197 (4865 - 5551)	-485	-9.3	.001
Unknown	710	684 (599 - 781)	26	3.8	.587
For foreign-born, country of origin according to implementation of 2007 immigration technical instructions (TI)
TI countries	2993	3384 (3095 - 3699)	-391	-11.6	.002
Non-TI countries	3861	4325 (4044 - 4625)	-464	-10.7	<.001
Race/ethnicity
Hispanic	3380	3953 (3563 - 4385)	-573	-14.5	<.001
Non-Hispanic American Indian	102	121 (100 - 148)	-19	-15.7	.151
Non-Hispanic Asian	3192	3355 (3093 - 3639)	-163	-4.9	.186
Non-Hispanic Black	2868	3135 (2963 - 3317)	-267	-8.5	.002
Non-Hispanic Native Hawaiian	75	75 (43 - 130)	0	0.0	1.00
Non-Hispanic White	1829	1954 (1812 - 2108)	-125	-6.4	.085
Non-Hispanic Multiple/Unknown	99	55 (32 - 95)	44	80.0	.080
Age at TB diagnosis in years
0-4	401	464 (405 - 532)	-63	-13.6	.040
5-14	245	292 (241 - 352)	-47	-16.1	.061
15-24	1274	1494 (1360 - 1641)	-220	-14.7	<.001
25-44	3893	4098 (3897 - 4309)	-205	-5.0	.048
45-64	3434	3846 (3624 - 4082)	-412	-10.7	<.001
65+	2292	2358 (2240 - 2482)	-66	-2.8	.339
Unknown	6	1 (1 - 1)	5	500.0	.041
Disease location
Pulmonary only	7976	8751 (8436 - 9078)	-775	-8.9	<.001
Extrapulmonary only	2383	2594 (2465 - 2730)	-211	-8.1	.003
Both	1028	1169 (1031 - 1326)	-141	-12.1	.026
Unknown	158	27 (3 - 211)	131	485.2	.344
Case verification
Positive culture	8876	9706 (9423 - 9997)	-830	-8.6	<.001
Positive NAA†	57	--	--	--
Positive smear	91	63 (45 - 89)	28	44.4	.084
Clinical case	1630	1426 (1243 - 1637)	204	14.3	.048
Provider diagnosis	891	1364 (1246 - 1492)	-473	-34.7	<.001
Homeless in the year prior to TB diagnosis
Yes	571	695 (623 - 774)	-124	-17.8	<.001
No	10797	11833 (11540 - 12133)	-1036	-8.8	<.001
Unknown	177	57 (22 - 147)	120	210.5	.094
Resident of a correctional facility at time of TB diagnosis
Yes	461	480 (389 - 593)	-19	-4.0	.682
No	11041	12055 (11796 - 12319)	-1014	-8.4	<.001
Unknown	43	7 (2 - 29)	36	514.3	.189
Excess alcohol use in the year prior to TB diagnosis
Yes	1382	1528 (1414 - 1652)	-146	-9.6	.013
No	9877	10889 (10641 - 11144)	-1012	-9.3	<.001
Unknown	286	180 (129 - 251)	106	58.9	.016
Injecting drug use in the year prior to TB diagnosis
Yes	152	216 (182 - 256)	-64	-29.6	<.001
No	11087	12165 (11831 - 12510)	-1078	-8.9	<.001
Unknown	306	203 (129 - 320)	103	50.7	.093
Non-injecting drug use in the year prior to TB diagnosis
Yes	828	922 (829 - 1026)	-94	-10.2	.046
No	10391	11438 (11178 - 11703)	-1047	-9.2	<.001
Unknown	326	221 (137 - 355)	105	47.5	.122
HIV status at time of TB diagnosis
Positive	706	797 (748 - 849)	-91	-11.4	.005
Negative	6337	7621 (7171 - 8100)	-1284	-16.8	<.001
Unknown	4502	4347 (4134 - 4572)	155	3.6	.185
Software for TB reporting‡
TIMS	4455	4775 (4552 - 5009)	-320	-6.7	.004
Other	7090	7771 (7470 - 8084)	-681	-8.8	<.001

*Expected case counts are derived from ratios (i.e., regression slopes on log-transformed observed counts). Because the sum of ratios is not the ratio of the sums, expected case counts stratified on case characteristics do not sum to overall case counts. All stratified count differences sum to within the 95% prediction interval (-688 to -1308) for the overall case count difference (-994).
† NAA = nucleic acid amplification test, which was not recorded as a TB case verification criteria until 2009, thus there are no comparable data from which to calculate expected values. In 2009, clinical cases include TB verified by positive interferon gamma release assay (IGRA) in lieu of tuberculin skin test, or by abnormal chest computerized tomography (CT) scan in lieu of chest radiograph; previously, such cases were verified by provider diagnosis because the National Tuberculosis Surveillance System did not collect IGRA or CT scan results prior to 2009.
‡TIMS = Tuberculosis Information Management System in operation since 1998. Other = National Electronic Disease Surveillance System-compliant software newly introduced in 2009.

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