Tuberculosis Mortality in California

Tuberculosis disease (TB) is an illness caused by the bacteria Mycobacterium tuberculosis. TB usually affects the lungs and spreads through the air when a person sick with TB coughs. Not everyone infected with the bacteria becomes sick. People who have been infected but are not sick have latent tuberculosis infection (LTBI). People with LTBI can become sick with TB disease in the future if they do not take treatment for LTBI. TB disease can have tragic consequences, including disability and death.1,2 Hospitalization is frequent (50% of people with TB disease)3 and costly ($180 million in 2020)2​.

The chance of death for a person with TB is increasing

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People with TB are at higher risk for death

During 2016-2020:

• Among all people aged 80 years or older, 9% die each year7, but one third with6  TB die​.
  
• Children die with TB. Eleven people aged less than 25 years died with TB, including four less than five years ol​d6​.
  
• Non-U.S.-born persons had the greatest burden of TB cases (82%) and deaths (86% of all deaths with TB)6​.
  
• The percentage of people born outside of the U.S. with TB who died increased from 11% to 14%6, while the percentage of U.S.-born people with TB who died remained stable at 9%.
  

• People with serious health conditions are more likely to die with TB, including those with diabetes,8​ HIV,8​ recent organ transplant,9​ and end-stage renal disease10​.  ​
  

​Deaths before treatment are increasing in California

About 2-3% of people with TB die before they can start treatment, or even before they know they have TB. These deaths account for about 25% of deaths in people with TB and can result from missed opportunities for diagnosing and treating TB. ​

The percentage of people with TB who die before starting treatment increased by 72% between 2017 and 2022 (from 1.8% in 2017 to 3.1% in 2022), even after adjusting for age of TB cases.6 

• The highest percentage of deaths before treatment was among U.S.-born White persons (7.4%) and U.S.-born Black persons (5.8%)^6,ii U.S.-born White and Black persons with TB are much more likely to experience homelessness and co-infection with HIV, which are also risk factors for death⁶
• Persons using alcohol, injection, or non-injection drugs, were more likely to die before treatment⁶
• People with serious health conditions are more likely to die with TB prior to treatment, including those with HIV, diabetes, recent organ transplant, end-stage renal disease, and other immunosuppression⁶
• Persons diagnosed with both COVID-19 and TB were more likely to die than persons with TB alone¹¹

TB and TB death can be prevented

​Death with TB can be avoided by prompt diagnosis and treatment of TB and by preventing TB disease. TB disease can be prevented by testing and treatment for LTBI ​among people with a risk for TB. Healthcare providers, community groups, and individuals can help by getting educated about TB risks, discussing TB risk, and asking for LTBI testing when a risk is identified. Those with positive test results can avoid getting sick with TB by taking treatment. Visit Tuberculosis Control Branch Homepage for more information and resources.

References​​

1. Lee-Rodriguez C, Wada PY, Hung YY, Skarbinski J. Association of Mortality and Years of Potential Life Lost With Active Tuberculosis in the United States.​ JAMA Netw Open. Sep 1 2020;3(9):e2014481. doi:10.1001/jamanetworkopen.2020.14481.

2. Tuberculosis Control Branch CDPH. Costs and Consequences of Tuberculosis in California. Accessed 2/23/2023, Cost and Consequences ​of Tuberculosis in California (https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CostsandConsequencesofTBinCA.pdf).​

3. Readhead A, Cooksey G, Flood J, Barry P. Hospitalizations with TB, California, 2009-2017. Int J Tuberc Lung Dis. Aug 1 2021;25(8):640-647. doi:10.5588/ijtld.21.0173
4. Miller TL, Wilson FA, Pang JW, et al. Mortality hazard and survival after tuberculosis treatment.​ Am J Public Health. May 2015;105(5):930-7. doi:10.2105/AJPH.2014.302431
5. Duque-Silva A, Robsky K, Flood J, Barry PM. Risk Factors for Central Nervous System Tuberculosis​. Pediatrics. Nov 2015;136(5):e1276-84. doi:10.1542/peds.2014-3958
6. Tuberculosis Control Branch CDPH. Data from: Report of Verified Case of Tuberculosis surveillance data. 2023.
7. Centers for Disease Control and Prevention NCHS. National Vital Statistics System, Mortality 1999-2020 on CDC WONDER Online Database. Accessed 2/28/2023. About Underlying Cause of Death, 1999-2020​ (http://wonder.cdc.gov/ucd-icd10.html).
8. Nguyen CH, Pascopella L, Barry PM. Association between diabetes mellitus and mortality among patients with tuberculosis in California, 2010-2014​. Int J Tuberc Lung Dis. Nov 1 2018;22(11):1269-1276. doi:10.5588/ijtld.18.0011
9. Katrak S, Han E, Readhead A, et al. Solid organ transplant recipients with tuberculosis disease in California, 2010 to 2020​. Am J Transplant. Dec 29 2022;doi:10.1016/j.ajt.2022.11.019
10. Okada RC, Barry PM, Skarbinski J, Chitnis AS. Epidemiology, detection, and management of tuberculosis among end-stage renal disease patients​. Infect Control Hosp Epidemiol. Nov 2018;39(11):1367-1374. doi:10.1017/ice.2018.219
11. Nabity SA, Han E, Lowenthal P, et al. Sociodemographic Characteristics, Comorbidities, and Mortality Among Persons Diagnosed With Tuberculosis and COVID-19 in Close Succession in California, 2020​. JAMA Netw Open. Dec 1 2021;4(12):e2136853. doi:10.1001/jamanetworkopen.2021.36853
12. Beavers SF, Pascopella L, Davidow AL, et al. Tuberculosis Mortality in the United States: Epidemiology and Prevention Opportunities​. Ann Am Thorac Soc. Jun 2018;15(6):683-692. doi:10.1513/AnnalsATS.201705-405OC

This webpage reflects available data as of August 1, 2023.                                                  

This fact sheet defines deaths with TB as death from any cause, during or before treatment. A previous study of deaths with TB found that 72% of deaths were TB-related.12 ​