(1145) Tuberculosis Mortality Rates in the United States From 1999-2020: An Area of Concern

Introduction: Tuberculosis (TB) is a major source of global morbidity and mortality. In the United States, the incidence of new TB cases has been declining from 1999 to 2020, but TB-related mortality has been increasing steadily over the last many years. We extracted data on the age-adjusted mortality rate (AAMR) of TB from 1999 to 2020, used joinpoint regression analysis to identify the endpoint years contributing to this uptick of the AAMR, and compared race and gender differences.

Methods: We describe a retrospective population-based study where we obtained AAMR data from 1999 to 2020 with TB as the principal diagnosis through the previously validated International Classification of Diseases code. The data was extracted through the Multiple Causes of Death (MCOD) database available through the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). We performed a joinpoint regression analysis of the overall AAMR of TB across different genders and races.

Results: From 1999 to 2020, the AAMR of TB per 1,000,000 population declined from 0.68 to 0.23 in 2015 and rose steadily to 0.27 in 2020. Joinpoint analysis showed the average annual percent change of -4.31 (CI -5.23 to -3.39, p< 0.001) from 1999 to 2020. We recognized 2001 and 2015 as two statistically significant joinpoints in that range, creating three segments. The annual percent change (APC) was -12.24 (CI -19.31 to -4.56, p< 0.004) from 1999 to 2001, -5.55 (CI -6.05 to -5.04, p< 0.001) from 2001 to 2015, and became 2.72 (CI 0.23 to 5.23, p 0.03) from 2015 to 2020. The APC in Asian or Pacific Islanders in the segment from 2014 to 2020 was 0.49 (CI -4.03 to 5.23, p 0.82) and was -0.71 (CI -4.14 to 2.83, p 0.67) in black or African Americans. The white population did not have any statistically significant change in AAMR around the time of this positive skew. The AAMR in males was higher than in females in any given year.

Conclusions: The slope of AAMR from TB, though declining from 1999 to 2015, has risen significantly till 2020. This could likely be attributed to the undiagnosed cases of latent TB causing its spread. This calls for strengthening public healthcare programs and collaboration with international partners to implement screening and appropriate treatment strategies.