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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.

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:
    • 40% Asian
    • 40% Hispanic or Latino
    • 14% non-Hispanic black or African-American
    • 6% non-Hispanic white
  • 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.
  • 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.
  • Seven countries accounted for 62% of the total of foreign-born persons with TB in 2005:
    • Mexico
    • Philippines
    • Vietnam
    • India
    • China
    • Haiti
    • Guatemala
  • 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.
  • 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.
  • The percentage of primary isoniazid (INH) resistance was approximately two times higher among foreign-born persons than among U.S.-born persons.
  • 75% of all MDR TB cases in 1999 through 2005 were among foreign-born persons.


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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.

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