Epi Profile Section 7 - At-Risk Populations
Risk factors among people diagnosed with TB have remained consistent from 2015 to 2019. Approximately a third of all cases, reported more than one risk factor for tuberculosis.
Table 8. Proportion of Risk Factors present in TB Cases, Texas. 2015-2019
| Risk Factor |
2015 |
2016 |
2017 |
2018 |
2019 |
Total |
|---|---|---|---|---|---|---|
| Non-US Born |
58.1% |
59.1% |
61.8% |
62.5% |
62.6% |
60.7% |
| Diabetes |
18.1% |
18.5% |
19.7% |
19.7% |
21.7% |
19.5% |
| Alcohol Abuse |
16.6% |
15.0% |
11.9% |
12.2% |
9.9% |
13.3% |
| Corrections* |
11.5% |
11.6% |
8.9% |
9.1% |
9.8% |
10.3% |
| Non-Injection Drug Use |
9.7% |
8.6% |
8.5% |
8.6% |
9.0% |
8.9% |
| HIV Positive** |
6.4% |
6.1% |
7.5% |
7.8% |
5.2% |
6.6% |
| Homelessness |
6.6% |
5.2% |
3.8% |
4.4% |
3.8% |
4.8% |
| Injection Drug Use |
2.7% |
1.8% |
1.1% |
2.0% |
1.1% |
1.8% |
| Total |
1,327 |
1,246 |
1,118 |
1,129 |
1,159 |
5,979 |
| *TB cases diagnosed in a correctional facility **Among Texas TB cases with HIV status reported |
||||||
Table 9. TB Cases with Multiple Risk Factors for TB, Texas, 2015-2019
| Risk Factors Reported |
2015 |
2016 |
2017 |
2018 |
2019 |
Total |
|---|---|---|---|---|---|---|
| 0 |
20.3% |
19.1% |
19.4% |
18.6% |
18.9% |
19.3% |
| 1 |
43.0% |
47.2% |
46.9% |
45.9% |
46.4% |
45.8% |
| >1 |
36.7% |
33.7% |
33.7% |
35.5% |
34.47 |
34.9% |
| Total |
1,327 |
1,246 |
1,118 |
1,129 |
1,159 |
5,979 |
Persons with Diabetes Mellitus
- People with diabetes are at a higher risk of progressing from TB infection to active TB disease. Diabetes is the most commonly reported co-morbidity among TB cases in Texas.
- In 2019, 21.7% of Texas TB cases also had diabetes mellitus compared to 20.7% of US TB cases with diabetes overall in 2019.[1]
- TB cases with co-morbid diabetes are likely to experience treatment complications.
- Texas TB cases with co-morbid diabetes have a 1.88 times higher risk of dying from TB compared to non-diabetic cases.
Persons with Human Immunodeficiency Virus (HIV)
- Persons with HIV have a weakened immune system and can progress more rapidly from TB infection to active TB disease.
- The 2018 TB case rate among Texans living with HIV is estimated at 82.9 per 100,000 and is 20.7 times higher than the state TB case rate.
- In 2019, 90.8% of Texas cases had an HIV test result reported, and of Texas TB cases with HIV status reported, 5.2% were HIV-positive compared to 7.4% of US TB cases in 2019.[1]
- For 2019, Texans with TB who were also HIV-positive have 2.14 times higher risk of dying from TB compared to HIV-negative cases. TB cases that are HIV positive also have twice the risk of being reported as lost to follow-up and not finishing TB medications compared to cases that are HIV negative.
Persons with reported substance abuse
- For 2019, 9.92% of Texas TB cases reported alcohol abuse, 8.97% reported non-injection drug use, and 1.12% reported injection drug use. For the US overall, in 2019 these proportions were 8.1%, 7.5%, and 1.2% respectively.[1]
- TB cases with reported alcohol abuse have 1.75 times the risk of death related to TB compared to cases with no alcohol abuse. They also have 1.78 times the risk of being reported as lost to follow-up compared to other cases. TB cases with reported injection drug use have 3.38 times the risk of becoming lost to follow-up and not finishing TB medication.
- TB cases with reported non-injection drug use have a 1.79 higher risk of being reported as lost to follow-up and not finishing TB medication compared to cases with no such drug abuse.
- There is a higher probability of reported substance abuse among cases who are HIV-positive, cases experiencing homelessness, and cases that were reported from a correctional facility. Substance abuse may contribute to poorer treatment outcomes for these cases.
Figure 4. Proportion of Substance Abuse* Among TB Cases in Texas, 2019
*Defined as alcohol abuse, injection drug use, and non-injection drug use.
Persons experiencing homelessness
- The 2019 TB case rate among Texans experiencing homelessness is estimated at 170.2 per 100,000—42.6 times higher than the state TB case rate and 60 times higher than the US rate.
- In 2019, 3.80% of Texas TB cases reported homelessness compared to 4.6% of US cases.[1]
- Various factors, such as population mobility and shelter conditions, increase the potential for TB to spread within this population and those that serve them.
- TB cases experiencing homelessness also have 4.03 times the risk of being reported as lost to follow-up and not finishing TB medications compared to cases not reporting homelessness.
Incarcerated persons
- In 2019, 9.8% of Texas TB cases were reported from a correctional facility compared to 3.1% of US cases.[1]
- The high turnover of offenders, the frequent movement of offenders within and between correctional facilities, and the crowded conditions in correctional facilities can increase the potential for TB to spread within this population and among those that serve them.
- TB cases reported from correctional facilities have a 5.17 times higher risk of being reported as lost to follow-up and not finishing their TB medications compared to cases who were not incarcerated.
1. Centers for Disease Control and Prevention (CDC). Reported Tuberculosis in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, CDC; 2020.
Table of Contents | An Overview of Tuberculosis in Texas | Geographic Distribution of Tuberculosis in Texas | Affected Populations | Case Diagnosis | Recent Transmission | Mortality | Risk Factors Associated with Tuberculosis | Drug Resistant TB | Public Health Follow-Up Outcomes | Reporting Requirements | References