Methods: We obtained mortality data from the National Center for Health Statistics (NCHS), which receives information from death certificates from all 50 states, including demographic information and cause of death. The U.S. Multiple Cause of Death Files were searched from 2003 through 2013 for a listing of TB as the primary cause of death (ICD10 codes A16-A19). We first examined the overall distribution of demographic factors of patients dying of TB in the U.S.. In order to test the hypothesis that race and ethnicity would be associated with CNS disease, we performed multiple logistic regression to determine the adjusted association of race and ethnicity with CNS disease among all TB deaths.
Results: Over a 10-year period (2003-2013), TB was the primary cause of death among 6,573 individuals in the U.S.: 4,959 (75%) with pulmonary TB, 910 (14%) with extra-pulmonary (non-CNS) TB, 160 (2%) with CNS TB, and 544 (8%) with miliary TB. Compared with pulmonary TB deaths, deaths due to CNS TB were more likely to occur in younger age groups (p<0.001) and among non-White race/ethnicity groups (77% vs 57%, p<0.001). In multivariate logistic regression, after adjusting for age, sex, and residency status, non-White race/ethnicity remained significantly associated with CNS disease among all TB deaths.
Conclusion: We observed racial differences in the clinical manifestation among patients dying of TB in the U.S. over a 10-year period. The contribution of co-morbid conditions (including HIV and diabetes mellitus) will be examined in future analyses.