Extrapulmonary Tuberculosis in the United States

TLDR

In the United States, pulmonary tuberculosis has declined steadily since the 1960s, whereas extrapulmonary tuberculosis has declined more slowly, representing about 17.5% of cases in 1986 and disproportionately affecting racial/ethnic minorities, foreign‑born individuals, and children. Adjusted analyses show that extrapulmonary tuberculosis is most common in children and is more prevalent among black, Asian, American Indian, female, and foreign‑born patients, with demographic shifts partly explaining its slower decline over time.

Abstract

From 1963 to 1986, the number of reported cases of pulmonary tuberculosis in the United States declined an average of 5.0% annually, and the number of cases of extrapulmonary tuberculosis declined an average of 0.9% annually over the same period. In 1986, 17.5% of all cases of tuberculosis were extrapulmonary. Of pulmonary cases, 63.0% occurred among racial ethnic minorities and the foreign-born, whereas of extrapulmonary cases, the respective proportion was 71.2%. After adjustment for other variables, the proportion of extrapulmonary tuberculosis among all patients with tuberculosis by age was found to be largest in children and generally to decrease with increasing age, larger among black, Asian, and American Indian than among non-Hispanic white patients, larger among female than among male patients, and larger among the foreign-born than among patients born in the United States. The smaller decline in extrapulmonary tuberculosis over the years may be partially due to changes in the demographic characteristics of patients with tuberculosis. Considerable differences in susceptibility to different sites of extrapulmonary tuberculosis by age, race/ethnicity, sex, and country of origin were found. The reasons for these differences remain largely unexplained.