Tuberculosis in the Inner City: Impact of a Continuing Epidemic in the 1990s

Tuberculosis cases have recently declined in the United States, renewing interest in disease elimination. We examined the epidemiology of tuberculosis from 1991 through 1997 at an inner-city public hospital and assessed population-based tuberculosis rates by ZIP code in the 8 metropolitan Atlanta co...

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Bibliographic Details
Published in:Clinical infectious diseases 1999-11, Vol.29 (5), p.1138-1144
Main Authors: Sotir, Mark J., Parrott, Patricia, Metchock, Beverly, Bock, Naomi N., McGowan, John E., Ray, Susan M., Miller, Lincoln P., Blumberg, Henry M.
Format: Article
Language:English
Subjects:
AIDS
AIDS/HIV
Bacterial diseases
Biological and medical sciences
Clinical Articles
Epidemiology
Female
Georgia - epidemiology
HIV
HIV Infections - epidemiology
Human bacterial diseases
Humans
Incidence
Infectious diseases
Inner cities
Male
Medical sciences
Mycobacterium tuberculosis
Notifiable diseases
Preventive medicine
Public health
Rifampin - therapeutic use
Time Factors
Tuberculosis
Tuberculosis - epidemiology
Tuberculosis and atypical mycobacterial infections
USA, Georgia, Atlanta
ZIP codes
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Summary:Tuberculosis cases have recently declined in the United States, renewing interest in disease elimination. We examined the epidemiology of tuberculosis from 1991 through 1997 at an inner-city public hospital and assessed population-based tuberculosis rates by ZIP code in the 8 metropolitan Atlanta counties. During the 7 years, 1378 new patients had tuberculosis diagnosed at our hospital (mean, 197 patients/year), accounting for 25% of tuberculosis cases in Georgia. Coinfection with human immunodeficiency virus (HIV) was common, but a significant decrease in the proportion of HIV-infected patients with tuberculosis was noted over time. Most patients were members of a minority group (93%) and were born in the United States (96%). Two inner-city ZIP code areas had annual tuberculosis rates >120 cases per 100,000 persons, and 8 ZIP code areas had annual rates of 47-88 cases per 100,000 persons between 1993 and 1997, compared with the annual national average of 8.7 cases per 100,000 persons. Our hospital continues to care for large numbers of tuberculosis patients, and rates of tuberculosis remain high in the inner city. These data mandate a concentration of efforts and resources in urban locations if tuberculosis control and elimination is to be achieved in the United States.
ISSN:1058-4838
1537-6591
DOI:10.1086/313453