Estimated Health and Economic Outcomes of Racial and Ethnic Tuberculosis Disparities in US-Born Persons

Importance Despite significant progress made toward tuberculosis (TB) elimination, racial and ethnic disparities persist in TB incidence and case-fatality rates in the US. Objective To estimate the health outcomes and economic cost of TB disparities among US-born persons from 2023 to 2035. Design, Setting, and Participants Generalized additive regression models projecting trends in TB incidence and case-fatality rates from 2023 to 2035 were fit based on national TB surveillance data for 2010 to 2019 in the 50 US states and the District of Columbia among US-born persons. This baseline scenario was compared with alternative scenarios in which racial and ethnic disparities in age- and sex-adjusted incidence and case-fatality rates were eliminated by setting rates for each race and ethnicity to goal values. Additional scenarios were created examining the potential outcomes of delayed reduction of racial and ethnic disparities. The potential benefits of eliminating disparities from differences between baseline and alternative scenario outcomes were quantified. Data were analyzed from January 2010 to December 2019. Exposures Non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Black, Hispanic, non-Hispanic Native Hawaiian or Other Pacific Islander, or non-Hispanic White race and ethnicity. Main outcomes and measures TB cases and deaths averted, quality-adjusted life years gained, and associated costs from a societal perspective. Results The study included 31 811 persons with reported TB from 2010 to 2019 (mean SD age, 47 24 years; 20 504 64% male; 1179 4% American Indian or Alaska Native persons; 1332 4% Asian persons; 12 152 38% Black persons; 6595 21% Hispanic persons; 299 1% Native Hawaiian or Other Pacific Islander persons; and 10 254 32% White persons). There were 3722 persons with a reported TB death. Persistent racial and ethnic disparities were associated with an estimated 11 901 of 26 203 TB cases among US-born persons (45%; 95% uncertainty interval UI, 44%-47%), 1421 of 3264 TB deaths among US-born persons (44%; 95% UI, 39%-48%), and an economic cost of 914 (95% UI, 675-1147) million from 2023 to 2035. Delayed goal attainment reduced the estimated avertable TB outcomes by 505 (95% UI, 495-518) TB cases, 55 (95% UI, 51-59) TB deaths, and 32 (95% UI, 24-40) million in societal costs annually. Conclusions and relevance In this modeling study of racial and ethnic disparities of TB, these disparities were associated with substantial future health and economic outcomes of TB among US-born persons without interventions beyond current efforts. Actions to eliminate disparities may reduce the excess TB burden among these persons and may contribute to accelerating TB elimination within the US.