From decline to rebound: a 25-year Joinpoint analysis of tuberculosis mortality in the United States, 1999–2023
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Following decades of consistent decline, tuberculosis (TB) mortality in the United States has exhibited indicators of stagnation since 2014. National-level summaries, however, conceal variability within demographic and geographic subgroups. Our objective was to quantify current trends and identify the demographics responsible for the deceleration. METHODS: Utilizing the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) mortality data (1999–2023), we computed age-adjusted mortality rates (AAMR) for all fatalities with underlying ICD-10 codes A16–A19. Joinpoint regression was utilized to calculate annual percent changes (APC) and average annual percent changes (AAPC) overall and stratified by sex, age, race/ethnicity, census area, and urbanization. RESULTS: Tuberculosis-related fatalities decreased from 911 in 1999 to 566 in 2023, resulting in an overall annual average percentage reduction of −3.36% (95% CI −4.55% to −2.15%). In 2014, the national trend flipped; the APC transitioned from −5.86% (1999–2014) to +1.64% (2014–2023). Males encountered a more pronounced deceleration (APC −0.75% post-2011) compared to females. Adults aged 45–54 years experienced a fall of 5.01% per annum until 2017, followed by an increase of 3.71% per annum until 2023. Comparable reversals transpired in the 65–74 age cohorts, while individuals aged 85 and above had a consistent linear fall (APC −3.91%). The South and Northeast demonstrated the most pronounced reversals post-2015, with annual percentage changes of +1.98% and +3.03%, respectively. Metropolitan counties had a resurgence post-2015, with an increase of 2.69%, while non-metropolitan regions stabilized. Non-Hispanic Black adults experienced the most significant early drop (APC −9.12%, 1999–2013) and Non-Hispanic Asian adults continued to represent the largest burden group in 2023. CONCLUSIONS: U.S. tuberculosis mortality has shifted from a rapid drop to stagnation or resurgence, particularly evident among middle-aged and older adults, males, urban inhabitants, and those in Southern and Northeastern states. Urgent, equity-centered actions are essential to avert further recurrence and expedite elimination.
Source: BMC Infectious Diseases
Authors: Yuanyuan Xiao, Tao Xiang
Institution: Third People's Hospital of Chengdu
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W4417493681