Tuberculosis among U.S.-born Americans decreased by more than 45% in the last two decades—but the potentially fatal bacterial lung infection continues to prey on racial and ethnic minorities, particularly Native American and Native Alaskan men.

While 72% of TB cases in the United States occur among foreign-born people, new research by the Stanford Prevention Policy Modeling Lab focuses on U.S.-born Americans between 2000 and 2019 in an attempt to measure TB incidence as well as the effects of social determinants of health on underserved populations.

“Measuring racial/ethnic disparities in TB incidence rates may help inform our understanding of the effect of structural racism on health and allows assessment of whether these disparities are closing over time,” PPML members wrote in their new study published in the Annals of Internal Medicine. 

“The United States has made enormous strides toward eliminating TB, but like so many outcomes in our health system, that progress has been felt unequally,” said Joshua Salomon, PhD, a professor of health policy and senior fellow at the Freeman Spogli Institute for International Studies and one of the study authors. “We have to continue to focus on reducing unacceptable disparities, and one thing this study shows is that those disparities are a big part of why TB elimination has been such an elusive goal.” 

Salomon heads up the multi-institution collaborative of experts ranging from epidemiology to economics from eight institutions across the country including Stanford, Harvard, Yale, and the Massachusetts Department of Public Health. The research was done under a grant from the Centers for Disease Control and Prevention’s epidemiologic and economic modeling project. The lead author of the study is Yunfei Li, ScD, a postdoctoral research fellow at the Harvard. T.H. Chan School of Public Health and lab member.

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The modeling lab found that compared with non-Hispanic whites, TB incidence rate ratios were as much as 14.2 times higher for Native Americans, Alaska Natives, Asian-Americans, Blacks and Hispanics. Females and younger people, as well as those with recently acquired TB infections, had greater relative disparities. But men were found to have the absolute greater disparities.

One of bleakest findings in the study is that an estimated 18,000 excess TB cases are due to racial and ethnic disparities. Eliminating these disparities among AI/AN persons, females and younger persons, the researchers found, could reduce overall TB incidence by more than 60% among the U.S.-born population.

“Reducing barriers to TB prevention activities and ensuring that all persons have access to affordable and effective TB services are essential for accelerating progress toward population-level TB elimination,” the researchers wrote. “Ongoing measurement of disparities will be needed to track progress toward these targets. Public health action to address disparities requires the collection of evidence to determine the causes of these disparities and the efficiency of interventions to close them.”

The prevention policy lab also conducts research on viral hepatitis, HIV/AIDS, sexually transmitted diseases, adolescent and school health, using modeling and data analytics to improve public health decision-making, with emphasis on reducing health disparities across all areas.