Tuberculosis Health Disparities in the United States: Who Is Most Affected, and Why

TB does not affect everyone equally. Some groups live in communities with higher rates of active TB disease, and so face a higher risk of exposure. Social, economic and demographic factors all shape a person's risk.

Health disparities

A health disparity is a disease occurring at higher levels in some groups than in others — differences that can follow race or ethnicity, health conditions or geography.

Social determinants of health are the non-medical factors that shape health: the conditions in which people are born, grow, work, live and age, and the wider forces and systems behind them. Poverty, unequal access to care, lack of education, stigma and racism are linked to disparities — stigma about TB, for example, can keep people from seeking care or follow-up. In the United States, TB hits hardest the groups that have historically faced the greatest obstacles to health care.

Who is most affected

Race and ethnicity. In 2023, 90.1% of U.S. TB cases were among people of racial and ethnic minority groups. Groups especially affected include Asian, Black or African American and Hispanic or Latino people.

Health. Conditions such as diabetes, cancer and HIV, and certain medicines, weaken the immune system, making TB disease likelier after infection.

Place. As in earlier years, in 2023 four states reported half of all U.S. cases: California, Texas, New York (including New York City) and Florida.

Birthplace. Exposure is far more likely outside the United States, so people born in, or often traveling to, countries where TB is more common are more likely to be exposed. In 2023 the TB rate was 18.5 times higher among people born outside the United States than among the U.S.-born.

Other groups: people experiencing homelessness and people who live or work in correctional facilities.

What stands in the way

TB is hard to diagnose, treat and control, and shrinking resources and lost public health capacity — access to care, and clinical and public health expertise — make it harder.

Long treatment. TB treatment takes several months, and some people can't or won't take medicine that long. People with TB disease who don't take their medicine correctly may get sick again, spread TB, or develop drug-resistant TB. People with inactive TB (latent TB infection) feel well, have no symptoms and can't spread it — so they may not see treatment as a priority. Yet without treatment, 1 in 10 will develop TB disease, which can spread and kill.

Socioeconomic factors can raise risk and make treatment harder: poverty, and limited access to quality health care, jobs, housing and transportation. Language barriers and cultural factors — health knowledge, stigma, values and beliefs — may also put some groups at higher risk.

What CDC is doing

CDC works to find the underlying causes of TB disparities and to develop strategies for health equity.

Partnerships

• works with national and international health organizations on TB among immigrants and refugees;
• supports the TB Elimination Alliance, a national partnership of community leaders, to increase knowledge, testing and treatment in communities at higher risk;
• funds the TB Centers of Excellence for training, education and medical consultation;
• works with We Are TB, a community of TB survivors, people in treatment and their families.

Communication and outreach

• a Spanish-language TB website, and culturally and linguistically appropriate materials on Find TB Resources;
• the multilingual Think. Test. Treat TB campaign, encouraging testing and treatment of inactive TB;
• personal stories of people treated for TB and of TB control workers;
• keeping providers current on diagnostics and treatment, and leading community outreach.

Data

• national reports of TB cases and rates by sex, race and ethnicity, risk factors and location;
• two research consortiums studying better treatments and TB risk in people with certain medical conditions.

More: Health Disparities in HIV, Viral Hepatitis, STDs, and Tuberculosis. Materials are free to order from CDC-INFO On Demand.

Sources

Based on "Health Disparities in Tuberculosis," Centers for Disease Control and Prevention, January 31, 2025; a work of the United States government in the public domain. The source's stock photograph is not reproduced.