Trends in Mortality of Tuberculosis Patients in the United States: The Long-Term Perspective

Abstract

To describe long-term trends in tuberculosis (TB) mortality and to compare trends estimated from two different sources of public health surveillance data. Trends and changes in trend were estimated by joinpoint regression. Comparisons between data sets were made by fitting a Poisson regression model. Since 1900, TB mortality rates estimated from death certificates have declined steeply, except for a period of no change in the 1980s. This decade had long-term consequences resulting in more TB deaths in later years than would have occurred had there been no flattening of the trend. Recent trends in TB mortality estimated from National Tuberculosis Surveillance System (NTSS) data, which record all-cause mortality, differed from trends based on death certificates. In particular, NTSS data showed TB mortality rates flattening since 2002. Estimates of trends in TB mortality vary by data source, and therefore interpretation of the success of control efforts will depend on the surveillance data set used. The data sets may be subject to different biases that vary with time. One data set showed a sustained improvement in the control of TB since the early 1990s whereas the other indicated that the rate of TB mortality was no longer declining.