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Epidemiology of Tuberculosis in Correctional
Facilities, United States, 1993-2011
Surveillance, Epidemiology
and Outbreak Investigations Branch
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention (CDC)
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination
The National Tuberculosis (TB) Surveillance System

Database of all confirmed cases of TB disease reported to
CDC
 A confirmed case is one that is laboratory confirmed, meets the
clinical case definition, or is confirmed by the provider (in absence
of adequate laboratory or clinical information)

Since 1993, collected demographic, risk factor, clinical, and
laboratory information on TB cases residing in correctional
facilities at the time of diagnosis
Surveillance Reporting for
Residence of a Correctional Facility


Resident of correctional facility at the time of TB diagnosis (Yes, No, or
Unknown)
Types of correctional facilities:







Federal Prison
State Prison
Local Jail
Juvenile Correctional Facility
Other Correctional Facility
Unknown
A separate question about “Immigration and Customs Enforcement” (ICE)
custody was added in 2009
 Persons in ICE custody can be housed in stand-alone ICE detention centers or other
correctional facilities.
 Questions pertaining to TB patients diagnosed in ICE facilities were 80% complete
in 2009; 95% complete in 2011.
TB Cases in Correctional Facilities

In 2011, a total of 9,946 TB cases ≥ 15 years old were reported in
the United States
 9,884 of those (99.4%) had information on residence in correctional
facilities
 424 (4.3%) cases were reported as residents of correctional facilities at
time of TB diagnosis

Between 1993 and 2011, 3.8% (n=11,721) of TB cases reported in
the U.S. were residents of correctional facilities at the time of
diagnosis.
* http://www.cdc.gov/tb/topic/populations/correctional/default.htm
Counts of TB Cases in Correctional Facilities
Compared to All TB cases, 1993-2011
30,000
TB Cases (Count)
25,000
TB Cases in Correctional Facilities
Total TB Cases
20,000
15,000
10,000
5,000
0
Year of Report
TB Cases in Correctional Facilities,
Percentage of All Reported TB Cases, 1993-2011
9
Percentage of all TB Cases
8
7
6
5
4
3
2
1
0
Year of Report
Percent of TB Cases in Correctional Facilities by
Type of Facility, 1993-2011
Unknown
0.4%
Juvenile Facility
1%
Federal Prison
7%
State Prison
31%
Other
10%
Local Jail
51%
TB Cases in Correctional Facilities in
U.S.-born and Foreign-born Persons, 1993-2011
30%
Foreign Born
Unknown Origin of Birth
U.S. Born
1%
69%
Number of TB Cases in Correctional Facilities in
U.S.-born and Foreign-born Persons, 1993-2011
1000
Number of TB Cases
900
800
700
600
U.S. Born
500
Foreign Born
400
300
200
100
0
Year
TB Cases in Correctional Facilities by Race/Ethnicity and
Percent of Foreign Born, 1993–2011
5000
4500
Number of TB Cases
4000
3500
3000
2500
U.S. Born
2000
Foreign Born
1500
1000
500
4%
74%
4%
95%
12%
Black
Hispanic
White
Asian
Other*
Percent Foreign Born
0
Race/Ethnicity
Note: Percentage indicates the proportion of foreign-born TB cases. Persons identified as white, black, Asian, or of other race are all non-Hispanic. Persons
identified as Hispanic might be of any race.
* Persons included in this category are American Indian/Alaska Native, Native Hawaiian or other Pacific Islander, multiple race, or unknown race and
comprise <2% of all incarcerated TB cases.
Percent of TB Cases in Correctional Facilities
by Immigration and Customs Enforcement (ICE)
Status, 2011
37%
Not in ICE Custody
In ICE Custody
63%
TB Cases in Correctional Facilities by Type of Facility and
Immigration and Customs Enforcement (ICE) Status, 2011
Count of Cases by ICE Status
160
140
120
100
80
In ICE Custody
Not in ICE Custody
60
40
20
0
Local Jail
State Prison
Other
Federal
Prison
Type of Correctional Facility
TB Cases in Correctional Facilities by Age Group and Percent in
Immigration and Customs Enforcement (ICE), 2011
100%
90%
80%
ICE Status
70%
60%
In ICE
50%
Not in ICE
40%
30%
20%
10%
0%
15-24
25-44
45-64
Age Group (years)
65+
TB Cases in Correctional Facilities by
Age Group, 1993-2011
1.5%
0.1%
12.5%
23.2%
Age 0-14
Age 15-24
Age 25-44
Age 45-64
Age 65+
62.7%
NOTE: Data for ages missing/unknown each accounted for <0.1% of outcomes.
TB Cases ≥ Age 15 in Correctional Facilities
by Age Group, 1993-2011
1,200
Age 65+
Age 45-64
1,000
Number of TB Cases
Age 25-44
Age 15-24
800
600
400
200
0
Year of Report
NOTE: For any year depicted, missing/unknown data accounted for <0.1% of outcomes.
TB Cases < Age 15 in Correctional Facilities by
Correctional Facility Type, 1993-2011
9%
9%
Juvenile
Correction Facility
Local Jail
Unknown
82%
Number of TB Cases in Correctional Facilities
by Sex, 1993-2011
1,200
Number of TB Cases
1,000
800
600
Male
Female
400
200
0
Year of Report
TB Cases in Correction Facilities by Race/Ethnicity,
1993-2011
1.3%
0.3%
2.8%
16.8%
Asian
Black
42.2%
Hispanic
White
Other *
Unknown
36.6%
* “Other” includes groups comprising <2% of total incarcerated TB cases (American Indian, Native Hawaiian/Pacific Islander, or Multiple Races)
TB Cases in Correctional Facilities by
Race/Ethnicity, 1993-2011
1,200
Number of TB Cases
1,000
800
Asian
Black
600
Hispanic
White
400
Other *
200
0
Year of Report
* “Other” includes groups comprising <2% of total incarcerated cases (American Indian, Native Hawaiian/Pacific Islander, or Multiple Races). Incarcerated
TB cases of unknown race/ethnicity are 0.3% of total cases and are not shown.
Percent of TB Cases in Correctional Facilities by
Whether HIV Test Results Known*, 1993-2011
35%
HIV Status Known*
HIV Status
Unknown
65%
*Known HIV status includes positive, negative and indeterminate results.
Percent of TB Cases by HIV Status and
Correctional Facility Status, 1993–2011
50
45
TB Cases not in Correctional Facilities
40
TB Cases in Correctional Facilities
Percent
35
30
25
20
15
10
5
0
Positive
Negative
Indeterminate
Refused
HIV Status
Not offered
Unknown
Treatment of TB Cases in Correctional Facilities by Use of
Directly Observed Therapy (DOT), 1993-2009
9%
2%
18%
Both Directly Observed and Self
Administered
Totally Directly Observed
Totally Self Administered
Unknown
71%
Percent of TB Cases in Correctional Facilities at the Time of
Diagnosis by Treatment Completion, 1993-2009
8%
2% 1%
11%
Completed Therapy
Died
Lost
Moved
5%
Other
Refused
73%
NOTE: Data for “Adverse Treatment Event” and “Unknown” each accounted for <0.1% of outcomes.
Percent of TB Cases by Treatment Completion Status
and Correctional Facility Status, 1993-2009
90
80
70
Percent
60
50
All TB Cases
40
All TB Cases in Correctional
Facilities
30
20
10
0
Completed
Therapy
Died
Lost
Moved
Other
Refused
Treatment Status
NOTE: Data for “Adverse Treatment Event” and “Unknown” each accounted for <0.1% of outcomes.
Percent of TB Cases in Correctional Facilities by
Reported History of Excess Alcohol Use Status, 1993-2011
16%
No History of Excess Alcohol Use
History of Excess Alcohol Use
Unknown History of Alcohol Use
27%
57%
Percent of TB Cases in Correctional Facilities by Reported
History of Injection Drug Use, 1993-2011
16%
No History of Injection Drug Use
History of Injection Drug Use
Unknown History of Injection Drug
Use
11%
73%
TB Cases in Correctional Facilities by Reported
History of Non-Injection Drug Use Status, 1993-2011
17%
No History of Non-Injection Drug
Use
History of Non-Injection Drug Use
Unknown History of Non-Injection
Drug Use
26%
57%
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
National Center for HIV/AIDS, Viral Hepatitis, STD , and TB Prevention
Division of Tuberculosis Elimination