For many states to impact their rising TB case rates, a focus on at-risk populations like the foreign-born is required. Resources to assist TB program staff in reducing the impact of TB in foreign-born community are provided below.
TB Disparity in Foreign-born
Despite a downward trend nationally, TB continues to impact many US communities disproportionately. Over half of new TB cases in the U.S. occur among individuals born outside of the country. The TB rate in foreign-born persons was nearly 9 times that of those U.S. born.
This population presents a challenge to healthcare staff and TB programs for providing diagnosis and care. These challenges include the unequal distribution of TB risk factors and barriers which include:
- language
- social and environmental factors
- cultural and lifestyle behaviors
- socioeconomic factors
- limited access to healthcare
To control the tuberculosis rate in the US, TB programs must address TB disparities among the foreign-born.
In order for TB program staff to effectively impact case rates, they must gain a greater knowledge of immigrants and the foreign-born through continued work to identify local at-risk populations, and tailor TB Programs to foreign-born communities. Training and education is key to overcoming many of the barriers that exist between healthcare staff and the foreign-born community.
http://www.cdc.gov/mmwr/preview/mmwrhtml/00054855.htm
General Statistics
- The percentage of TB cases in foreign-born persons increased from 22% in 1986 to 55% in 2005.
- TB cases in U.S. among foreign-born:
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40% Asian
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40% Hispanic or Latino
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14% non-Hispanic black or African-American
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6% non-Hispanic white
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The number of reported cases of TB has decreased steadily since the peak of the resurgence in1992; however, the decline has been limited to US born persons.
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According to the 1990 census, foreign-born persons accounted for only 8 percent of the population; yet 36 percent of TB cases occurred in this group in 1993-1998.
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Seven countries accounted for 62% of the total of foreign-born persons with TB in 2005:
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Mexico
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Philippines
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Vietnam
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India
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China
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Haiti
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Guatemala
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95% of Asians with TB in the US were foreign-born (Asia accounts for the largest number of TB cases globally). The foreign-born also account for the majority (74%) of cases among Hispanics in the U.S. Many Hispanics diagnosed with TB in the US were born in Mexico and Latin America.
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In 2005, 20% of foreign-born persons had been in the United States for less than 1 year prior to their TB diagnosis; 25% between 1 and 4 years; and 55% for at least 5 years.
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The percentage of primary isoniazid (INH) resistance was approximately two times higher among foreign-born persons than among U.S.-born persons.
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75% of all MDR TB cases in 1999 through 2005 were among foreign-born persons.
RESOURCES AND REFERENCE MATERIAL
Journals and Articles
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Recommendations for Prevention and Control of Tuberculosis Among Foreign-Born Persons Report of the Working Group on Tuberculosis Among Foreign-Born Persons CDC MMWR September 18, 1998 / 47(RR16);1-26
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Preventing and Controlling Tuberculosis Along the U.S.-Mexico Border Work Group Report CDC MMWR 2001; 50 (No. RR-1)
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Trends in Tuberculosis ---United States, CDC MMWR March 23, 2006; 55 (No. 11)
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Tuberculosis in the United States, National Tuberculosis Surveillance System, Highlights from 2005. This CDC slide set provides trends for the recent past and highlights from data collected through the National TB Surveillance System for 2005, including slides about foreign-born.
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Tuberculosis Among Foreign-Born Persons in the United States, 1993-1998 JAMA, 2000.
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Rethinking the Socioeconomics and Geography of Tuberculosis Among Foreign-Born Residents in New Jersey, 1994-1999 CDC Medical News posted on the Body website excerpted from American Journal of Public Health 06.03; Vol. 93; No. 6: P. 1007-1012.
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Tuberculosis Among Foreign-Born Residents of Southern Florida, 1995 School of Public Health, UC Berkeley
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Immigrants and Tuberculosis New England Journal of Medicine, Volume 333:667-669, September 7, 1995 Number 10.
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Tuberculosis Among Foreign-born Persons in the United States: Achieving Tuberculosis Elimination American Journal of Respiratory and Critical Care Medicine
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Preventing Active Tuberculosis in Immigrants: Treating latent infections could reduce the high TB rate in the non-U.S. born Tuberculosis Prevention. InVivo Columbia University Health Sciences Volume 1 No 10, May 29, 2002.
Websites
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CDC's Division of Tuberculosis Elimination - News and updates, highlights, upcoming events, and information about DTBE are offered.
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TB Education and Training Network: The TB ETN Network brings TB professionals together to share resources and build education and training skills.
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FIND TB RESOURCES This website provides access to TB education and training information in a searchable database.
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CURE-TB, operated by the San Diego County TB control program, is a joint U.S.-Mexico referral system designed to improve the continuity of care for patients with active TB disease and their contacts who are at high risk.
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TBNet, under the Migrant Clinicians Network umbrella, is a multi-national tuberculosis patient tracking and referral project designed to work with mobile, underserved populations.
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Ten Against TB (TATB) is a bi-national initiative of ten U.S.-Mexico border states to facilitate cooperative efforts along the U.S.-Mexico border to reduce tuberculosis morbidity, mortality, and transmission by strengthening prevention and control programs.
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U.S. Immigration and Customs
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Lung Disease Data at a Glance: Tuberculosis. American Lung Association
The Southeastern National Tuberculosis Center is designated as a Regional Tuberculosis Training and Medical Consultation Center (RTMCC) via a funded cooperative agreement with the Centers for Disease Control and Prevention. Our RTMCC serves the Southeast U.S. region which consists of thirteen jurisdictions: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Puerto Rico, South Carolina, Tennessee, Virginia and the U.S. Virgin Islands. The Center welcomes inquiries from our Southeast region constituents regarding training, educational products, technical assistance, and medical consultation.