What to know
In 2023, among persons with tuberculosis (TB) disease, the most reported medical risk factor was diabetes mellitus. The most reported social risk factor was currently or formerly smoking or vaping tobacco.
Introduction
Anyone can get TB disease, but persons at higher risk for TB fall into two broad categories:
- Persons who are at risk of exposure to TB bacteria
- Persons who are at risk of developing TB disease once infected with TB bacteria
Key findings
In 2023, all jurisdictions fully implemented the revised national TB case report form, 2020 Report of Verified Case of Tuberculosis (RVCT). The new data collected on the revised form provide additional understanding of characteristics and risk factors among persons with TB disease.
CDC analyzes selected factors that impact a person's risk of becoming infected with TB bacteria or developing TB disease if infected. This year's annual report includes select new data, including hepatitis, pregnancy, smoking, history of experiencing homelessness, and history of working in select occupations.
CDC reports information on TB disease and medical and social risk factors, including:
- Diabetes mellitus
- Viral hepatitis
- Human immunodeficiency virus (HIV)
- History of or current smoking or vaping tobacco
- Alcohol or substance use
- Congregate settings (homeless shelters, correctional facilities, detention centers, and long-term care facilities)
- Select occupations
Health conditions
Some persons with weakened immune systems (as a result of certain medications or health conditions [such as diabetes or HIV]) are at higher risk of developing TB disease once infected with TB bacteria.
Diabetes mellitus
TB disease is a serious health threat, especially for persons with diabetes mellitus.
In 2023, 2,251 (23.4%) of persons with TB disease reported also having diabetes mellitus. A higher percentage of non-U.S.–born persons (25.6%) reported having diabetes mellitus compared with U.S.-born persons (16.3%).
Human immunodeficiency virus (HIV)
Coinfection with HIV is a major risk factor for persons with latent TB infection to develop TB disease.
Among persons with TB disease during 2023 who were alive at TB diagnosis and had a known HIV status, 4.9% had HIV coinfection. The percentage of HIV coinfection among persons with TB disease in the United States has been relatively stable since 2018.
TB disease in pregnancy
TB disease in pregnancy poses a substantial risk of morbidity to both the pregnant person and the fetus if not diagnosed and treated in a timely manner.
Among persons reported to be female in the 15–44 year old age group, the United States reported 55 TB cases among pregnant persons. This represents 1.0% of 15–24 year old females with TB disease and 3.1% of 25–44 year old females with TB disease.
Smoking or vaping tobacco
Smoking is associated with increased risk of TB disease. In the 2020 RVCT, the definition of "smoking" is consuming tobacco (or nicotine) through:
- Combustible tobacco products (e.g., cigarettes)
- Electronic nicotine delivery systems (e.g., vapes, e-cigarettes)
In 2023, 2,834 (31.2%) persons 15 years of age or older with TB disease reported being a current or former smoker.
Substance use
Substance use is a risk factor for TB disease among persons who are infected with TB bacteria. Substance use can also present a barrier to TB diagnosis and treatment.
During 2023, reported types of substance use among persons 15 years of age or older with TB disease were:
- Excess alcohol use (7.9%)
- Noninjecting drug use (7.8%)
- Injecting drug use (1.1%)
Congregate settings
Congregate settings include homeless shelters, correctional facilities, detention centers, and long-term care facilities. Persons who live or work in congregate settings are at increased risk of becoming infected with TB bacteria if they share airspace with persons with TB disease. TB bacteria are spread through the air from one person to another.
Persons experiencing homelessness often do not have ready access to the medical care to diagnose latent TB infection or TB disease early. If left untreated, persons with latent TB infection can develop TB disease at any time and become sick.
Persons experiencing homelessness
In 2023, among persons 15 years of age or older with TB disease:
- 695 (8.3%) persons reported ever experiencing homelessness during their lifetime, and
- 536 (5.9%) persons reported experiencing homelessness within 12 months prior to TB diagnosis.
Residents of correctional facilities
In 2023, 324 (3.6%) persons 15 years of age or older with TB disease were residents of a correctional facility at the time of TB diagnosis. Of those persons, 174 (53.7%) were current residents of otherA types of correctional facilities.
Residents of long-term care facilities
In 2023, 126 (1.4%) persons 15 years of age or older with TB disease were residents of a long-term care facility at the time of TB diagnosis.
Occupation
Certain occupations have higher risk for exposure to TB bacteria. Persons have a higher risk of being exposed to TB bacteria who:
- Work in or frequently travel to countries where TB is common, including some countries in Asia, Africa, and Latin America
- Work in large group settings where TB is more common, such as homeless shelters, prisons or jails, and nursing homes
The 2020 RVCT collected information related to a person's history of working in select occupations. In 2023, persons 15 years of age or older with TB disease reported ever working as a:
- Health care worker (6.9%)
- Migrant worker (3.4%)
- Correctional employee (0.4%)
Explore the data tables
Resources
- Other type of correctional facility includes Immigration and Customs Enforcement detention centers, Indian reservation facilities (e.g., tribal jails), military stockades and jails, Federal Park police facilities, police lockups (temporary holding facilities for persons who have not been formally charged in court), juvenile facilities, and other correctional facilities not included in the other specific choices.