Tuberculosis Among American Indians and Alaskan Natives --
United States, 1985
In 1985, 22,201 cases of tuberculosis were reported to CDC, for
an
incidence rate of 9.3 cases per 100,000 U.S. population (1). Three
hundred and ninety-seven (2) of the 22,170 patients with known race
were American Indians and Alaskan Natives. The incidence rate for
this
group was 25.0/100,000 population, 4.4 times the rate of
5.7/100,000
for the white population (2).
The 397 tuberculosis cases among American Indians and Alaskan
Natives were reported from 144 (5) of the nation's 3,138 counties
(Figure 1). Three hundred and eighty-five (97) of these cases were
reported from the 32 states with reservations (Table 1). Eleven of
these states reported 326 (82) of these 385 cases. In these 11
states,
the ratio of the incidence of tuberculosis among American Indians
and
Alaskan Natives to the incidence among all other races ranged from
4.2
in Oklahoma to 30.4 in South Dakota and 31.4 in Minnesota. American
Indians and Alaskan Natives accounted for large proportions of
reported tuberculosis cases in Alaska and South Dakota (71 and 62,
respectively); however, they only comprise 14 of the Alaskan
population and 7 of the South Dakota population.
The median age of American Indians and Alaskan Natives with
tuberculosis was 45 years. One hundred and thirty-eight (35) of the
397 patients were less than 35 years of age. Reported by: Div of
Tuberculosis Control, Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: Paleopathological evidence has demonstrated the
existence of tuberculosis in the Americas in pre-Columbian times
(3).
However, the high rates of morbidity and mortality from
tuberculosis
observed among American Indians at the end of the last century have
been attributed to increased contact with the white civilization
(4).
This is also believed to be the case in Alaska, where the morbidity
rates from tuberculosis in the early 1950s were the highest ever
reported in the medical literature (5). Active case-finding,
treatment, and extensive use of preventive chemotherapy in the
1950s
and 1960s markedly reduced tuberculosis mortality and morbidity in
Alaska (6). However, the incidence rate of tuberculosis among
Alaskan
Natives in 1985 was still 10-fold higher than the national average.
In
some states, the risk of tuberculosis was up to 30-fold higher
among
American Indians than among other races.
Because tuberculosis among American Indians and Alaskan Natives
is
concentrated in well-defined geographic pockets, intensive use of
preventive measures may be particularly effective. In 1985, 35 of
American Indians and Alaskan Natives with tuberculosis were under
35
years of age, the age group for which preventive therapy is
routinely
recommended for infected persons with no additional risk factors
(7).
Directly observed therapy and incentives for compliance should also
decrease morbidity.
In addition, the prevalence of diabetes mellitus, which is a
recognized risk factor for tuberculosis, has increased among most
American Indian and Alaskan Native populations during the past 50
years and now ranges up to 50 (8). Preventive chemotherapy is
recommended for patients with diabetes who are infected with the
tubercle bacillus, regardless of their age (7). Tuberculin skin
testing is recommended for all young adult American Indians and
Alaskan Natives as well as for diabetics of any age. Preventive
therapy should be administered according to the current guidelines
(7).
Intentional isoniazid overdosage has been reported among
American
Indians (9), as it has among other populations (10). Thus,
physicians
should be familiar with treatment of isoniazid toxicity (11).
Because
of the risk of overdosage with self- administered therapy, directly
observed therapy should be used for persons with a history of
depression or suicidal tendencies.
CDC. Tuberculosis in minorities--United States. MMWR
1987;36:77-80.
Buikstra JE, ed. Prehistoric tuberculosis in the Americas.
Evanston, Illinois: Northwestern University Archaeological
Program, 1981.
Matthews W. Consumption among the Indians. NY Med J
1887;45:1-3.
Comstock GW, Philip RN. Decline of the tuberculosis epidemic in
Alaska. Public Health Rep 1961;76:19-24.
Johnson MW. Results of 20 years of tuberculosis control in
Alaska.
Health Serv Rep 1973;88:247-54.
American Thoracic Society, CDC. Treatment of tuberculosis and
tuberculosis infection in adults and children. Am Rev Respir
Dis
1986;134:355-63.
Sievers ML, Fisher JR. Diabetes in North American Indians. In:
Diabetes in America. Bethesda, Maryland: US Department of
Health
and Human Services, Public Health Service, National Institutes
of
Health, 1985:chapter XI, 1-19; DHHS publication no.
(NIH)85-1468.
Sievers ML, Cynamon MH, Bittker TE. Intentional isoniazid
overdosage among southwestern American Indians. Am J Psychiatry
1975;132:662-5.
Blanchard PD, Yao JDC, McAlpine DE, Hurt RD. Isoniazid overdose
in
the Cambodian population of Olmsted County, Minnesota. JAMA
1986;256:3131-3.
Sievers ML, Herrier RN. Treatment of acute isoniazid toxicity.
Am
J Hosp Pharm 1975;32: 202-6.
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