Tuberculosis in Indigenous Persons — United States, 2009–2019

Background Populations of indigenous persons are frequently associated with pronounced disparities in rates of tuberculosis (TB) disease compared to co-occurring nonindigenous populations. Methods Using data from the National Tuberculosis Surveillance System on TB cases in U.S.-born patients reported in the United States during 2009–2019, we calculated incidence rate ratios and risk ratios for TB risk factors to compare cases in American Indian or Alaska Native (AIAN) and Native Hawaiian or other Pacific Islander (NHPI) TB patients to cases in White TB patients. Results Annual TB incidence rates among AIAN and NHPI TB patients were on average ≥10 times higher than among White TB patients. Compared to White TB patients, AIAN and NHPI TB patients were 1.91 (95% confidence interval (CI): 1.35–2.71) and 3.39 (CI: 1.44–5.74) times more likely to have renal disease or failure, 1.33 (CI: 1.16–1.53) and 1.63 (CI: 1.20–2.20) times more likely to have diabetes mellitus, and 0.66 (CI: 0.44–0.99) and 0.19 (CI: 0–0.59) times less likely to be HIV positive, respectively. AIAN TB patients were 1.84 (CI: 1.69–2.00) and 1.48 (CI: 1.27–1.71) times more likely to report using excess alcohol and experiencing homelessness, respectively. Conclusion TB among U.S. indigenous persons is associated with persistent and concerning health disparities.