Ethnic, Racial, Regional Disparities in Tuberculosis Rates Prompt Call for Congress To Bolster TB Funding

American Lung Association
Thursday, 21 March 2002

A coalition of more than 80 public health organizations today issued a report urging Congress to avert a resurgence of tuberculosis in this country by increasing funding to fight the disease. The call for action comes as public health advocates around the world prepare to mark World TB Day on March 24.

"Tuberculosis anywhere in the world is a cause for concern here," said Philip Hopewell, M.D., former president of the American Thoracic Society; associate dean, San Francisco General Hospital, University of California/San Francisco; and member of the Institute of Medicine Committee on the Elimination of Tuberculosis.

"Two billion people - one-third of the world's population - are infected with the tuberculosis germ. Each year, approximately 8 million new cases occur and nearly 2 million people die from the disease. Globally, tuberculosis is the leading cause of death for people with AIDS and the leading cause of maternal mortality," he said.

TB is a preventable, treatable disease. While new cases of TB have been declining in the United States in recent years, there were still 16,377 cases of active TB reported in 2000. Ten to 15 million people in this country have latent TB infection. One in 10 will eventually develop active tuberculosis and could spread it to others.

"There are troubling signs that we have yet to truly conquer this ancient disease," he said.

For example:

- 17 states and the District of Columbia reported more cases of TB in 2000 than in 1999.

- There are persistent, unacceptable disparities in TB rates across racial and ethnic lines. In 2000, 77 percent of all reported TB cases occurred in racial and ethnic minorities.

- Estimates suggest that more than half of U.S. TB cases may occur in foreign-born individuals by 2002. Given the flow of immigrants and refugees into the United States from countries with high burdens of TB, this trend likely will continue.

- TB among U.S.-born individuals is a persistent problem in some regions of the U.S. For example, in the southeastern United States, 85 percent of new TB cases in 2000 were among U.S.-born individuals.

"Tuberculosis rebounds when it is neglected. In the early 1990s, it returned with a vengeance after decades of decline. The reason: A lack of political will to provide adequate funding to maintain effective tuberculosis control programs," said Lee B. Reichman, M.D., M.P.H., co-chair of the National Coalition for the Elimination of Tuberculosis (NCET) and former president of the American Lung Association.

"We face a similar situation today. Federal funding to fight TB over the past six years has not kept pace with inflation. TB elimination cannot be achieved without additional efforts," he said.

"The federal Centers for Disease Control and Prevention, state and local TB controllers and public health advocates are finding it very difficult to sustain the battle," said Sue Etkind, R.N., M.S., National TB Controllers Association and member of the Institute of Medicine Committee on the Elimination of Tuberculosis.

"The result will be increased tuberculosis rates in the future and a much longer timeline until we finally eliminate tuberculosis in the United States," she said.

It has been estimated that $528 million is needed to fully implement the recommendations of the Institute of Medicine, which in 2000 issued comprehensive guidelines for eliminating TB in the United States. Given the slowing trend in the rate of decline in cases of tuberculosis in 2001, the National Coalition for the Elimination of Tuberculosis recommends that Congress double project funding to $265 million for CDC's Division of Tuberculosis Elimination in FY03.

Founded in 1991, the National Coalition for the Elimination of Tuberculosis is a coalition of national, state and local public health, medical professional, health care and service organizations.

For more information, or to contact American Lung Association, see their website at: www.lungusa.org