State-level prevalence estimates of latent tuberculosis infection in the United States by medical risk factors, demographic characteristics and nativity

Abstract

Introduction Preventing tuberculosis (TB) disease requires treatment of latent TB infection (LTBI) as well as prevention of person-to-person transmission. We estimated the LTBI prevalence for the entire United States and for each state by medical risk factors, age, and race/ethnicity, both in the total population and stratified by nativity. Methods We created a mathematical model using all incident TB disease cases during 2013–2017 reported to the National Tuberculosis Surveillance System that were classified using genotype-based methods or imputation as not attributed to recent TB transmission. Using the annual average number of TB cases among US-born and non-US-born persons by medical risk factor, age group, and race/ethnicity, we applied population-specific reactivation rates (and corresponding 95% confidence intervals [CI]) to back-calculate the estimated prevalence of untreated LTBI in each population for the United States and for each of the 50 states and the District of Columbia in 2015. Results We estimated that 2.7% (CI: 2.6%–2.8%) of the U.S. population, or 8.6 (CI: 8.3–8.8) million people, were living with LTBI in 2015. Estimated LTBI prevalence among US-born persons was 1.0% (CI: 1.0%–1.1%) and among non-US-born persons was 13.9% (CI: 13.5%–14.3%). Among US-born persons, the highest LTBI prevalence was in persons aged ≥65 years (2.1%) and in persons of non-Hispanic Black race/ethnicity (3.1%). Among non-US-born persons, the highest LTBI prevalence was estimated in persons aged 45–64 years (16.3%) and persons of Asian and other racial/ethnic groups (19.1%). Conclusions Our estimations of the prevalence of LTBI by medical risk factors and demographic characteristics for each state could facilitate planning for testing and treatment interventions to eliminate TB in the United States. Our back-calculation method feasibly estimates untreated LTBI prevalence and can be updated using future TB disease case counts at the state or national level.

The cascade of care in testing and treatment of latent tuberculosis infection in liver transplant candidates

“…The LTBI rate in this study was unexpectedly higher than the reported rate in the United States (i.e., 2.7%), 33 which can be attributed to the high rate of foreign‐born individuals from TB‐endemic areas (16%) in our cohort. Our study highlights the importance of LTBI screening based on risk factors for TB 34 .…”

“…Other factors associated with indeterminate IGRA results that we did not explore, include medical comorbidities, including hepatitis C, and low lymphocyte counts. 24,30 The LTBI rate in this study was unexpectedly higher than the reported rate in the United States (i.e., 2.7%), 33 which can be attributed to the high rate of foreign-born individuals from TB-endemic areas (16%) in our cohort. Our study highlights the importance of LTBI screening based on risk factors for TB.…”

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“…The prevalence of LTBI may vary based on age group and ethnicity. In a study performed in US, the highest prevalence of LTBI was noted in persons ≥ 65 years among US-born persons and in persons between the ages of 45 and 64 years among non-US-born persons 11 .…”

“…The LTBI prevalence is very high in countries such as Haiti, Peru, Ethiopia, Somalia, Buthan and Vietnam (range: 42% to 55%) 10 . The estimated prevalence of LTBI in US is only 2.7% 11 . The prevalence of LTBI may vary based on age group and ethnicity.…”

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“…This was due to several challenges including multidrug-resistant (MDR)-TB and sub-optimal clinical and public health management of the condition in certain countries. In 2019, about 2.7 cases of TB were reported per 100,000 people [ 3 ].…”