Tuberculosis in Arizona, 2000

Morbidity
There were 16,372 cases of active tuberculosis (TB) reported in the United States (U.S.) in the year 2000.
Of these, 261 (1.6%) occurred in Arizona. While the U.S. has seen eight consecutive years of decline in
the number of cases since 1993, this trend is not apparent in Arizona. In 1992, at the height of the TB
resurgence nationwide, Arizona had 258 cases, nearly the same number as the 261 cases reported in
2000 (Table 1). The mean number of TB cases in Arizona from 1990 to 2000 was 273 with a minimum of
228 cases in 1993 and maximum of 324 cases in 1991. However, due to population growth statewide,
TB case rates have declined from 7.5 per 100,000 persons in 1990 to 5.1 in 2000. The latter is higher
than the Healthy People 2000 target rate of 3.5 per 100,000 persons, but lower than the national average
of 5.8 per 100,000 persons (Figure 1). Only 22 states have met or exceeded the 2000 target goal.
th

th

Arizona ranked 18 nationwide in TB case rates and 19 in number of cases in 2000. The majority of TB
cases in Arizona in 2000 were of Hispanic ethnicity (53.3%), followed by White, non-Hispanic (15.7%),
American Indian (11.5%), Asian (10.7) and Black, non-Hispanic (7.7%). The mean age was 46.5 years
and 68.2% were male (Table 2).

Table 1. Tuberculosis Cases and Case Rates per 100,000 Population, Arizona and United
States, 1990-2000
a

Arizona
b

Year

Cases

c

United States
Rate
Cases

Rate
7.5
8.6

25,701
26,283

10.3
10.4

1990
1991

275
324

Population
3,665,882
3,763,372

1992

258

3,858,825

6.7

26,673

10.5

1993
1994

228
247

3,946,975
4,036,875

5.8
6.1

25,287
24,361

9.8
9.4

1995

317

4,184,723

7.6

22,860

8.7

1996
1997

282
296

4,462,717
4,595,379

6.3
6.4

21,337
19,851

8.0
7.4

1998

254

4,722,097

5.4

18,361

6.8

1999

262

4,924,350

5.3

17,531

6.4

2000

261

5,130,632

5.1

16,372

5.8

a

Data from U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
b
Year reported reflects the year case was verified by ADHS.
c
1990 and 2000 population from 1990 and 2000 U.S. Census data, respectively. Interim years from Department of
Economic Security population projections.

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Figure 1. TB Case Rates per 100,000 Population,
Arizona and United States, 1990-2000
12
10
8
6
4
2
0
1990

1992

1994

1996

Arizona

United States

1998

2000

2000 Target

Table 2. Tuberculosis Cases by Ethnicity, Gender and Age Group, Arizona, 2000
Age Group

White, Not Hispanic
Male
Female
Total
Black, Not Hispanic
Male
Female
Total
d
Hispanic
Male
Female
Total
e
Native American
Male
Female
Total
f
Asian
Male
Female
Total
Unknown
Male
Female
Total
AGE GROUP TOTALS
Male
Female
TOTAL
(%)
a

No.

Total
a
(%)

Rate

9
2
11

33
8
41

(15.7)

1.3

4
0
4

3
1
4

17
3
20

(7.7)

13.3

40
11
51

22
7
29

14
9
23

93
46
139

(53.3)

10.7

2
1
3

4
1
5

8
7
15

2
4
6

17
13
30

(11.5)

12.9

1
0
1

2
1
3

6
5
11

1
3
4

5
4
9

15
13
28

(10.7)

29.5

0
0
0

0
0
0

0
0
0

2
0
2

0
0
0

1
0
1

3
0
3

(1.1)

3.6

5
7
12
(4.6)

5
1
6
(2.3)

19
14
33
(12.6)

69
22
91
(34.9)

46
19
65
(24.9)

34
20
54
(20.7)

178
83
261
(100.0)

(68.2)
(31.8)
(100.0)

5.1

Under 5

5 - 14

15 - 24

25 - 44

45 - 64

65+

2
0
2

1
0
1

1
0
1

9
4
13

11
2
13

0
0
0

0
0
0

2
1
3

8
1
9

3
7
10

2
1
3

12
11
23

0
0
0

1
0
1

0
0
0

b,c

Percent of total cases.
Rate per 100,000 population.
c
1990 and 2000 population from 1990 and 2000 U.S. Census data, respectively. Interim years from Department of Economic Security
population projections.
d
Persons of Hispanic origin may be of any race.
e
Includes American Indians and Native Alaskans
f
Includes Pacific Islanders
b

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Four of Arizona’s 15 counties accounted for 85% of the state’s TB cases. Maricopa County, which
includes Phoenix, the tenth largest metropolitan area in the U.S., led the state with 157 cases (60.2%).
Yuma County, on the U.S.-Mexico border, was second with 27 cases (10.3%). Pima County, also on the
U.S.-Mexico border and the location of Tucson, Arizona’s second largest urban area, had 23 cases
(8.8%). Pinal County, which contains Arizona’s two largest state prison facilities, three private prisons, an
INS processing center, and a county jail had 15 cases (5.7%); of these, 13 were diagnosed in a
correctional facility. Two of the remaining eleven counties, Greenlee and La Paz, reported no TB cases
in 2000. Yuma County had the highest rate among all counties (Figure 2).

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Risk Factors
Arizona has observed the same trend of an increasing proportion of cases among the foreign-born as
seen nationally. The year 2000 marks the first time the number of TB cases diagnosed in foreign-born
persons in Arizona exceeded the number of cases among the U.S.-born, 55.9% versus 44.1% (Figure 3).
The greatest proportion of foreign-born persons with TB in Arizona in 2000 were born in Mexico (66.0%).
Other reported countries of origin include Vietnam (5.4%), the Philippines (4.1%) and India (2.7%). The
remaining 32 cases are from 22 other countries (Figure 4).

Figure 3. Foreign-born TB Cases,
Arizona, 1990 - 2000

Figure 4. Reported Country of
Birth, Arizona TB Cases, 2000

100%
Mexico
66%

80%
60%
40%
20%

Other
22%

0%
1990 1992 1994 1996 1998 2000

Foreign

U.S.

Mexico

Vietnam

India

Other

Phillipines

Age distribution differs between U.S.-born and foreign-born persons with a greater mean age among
those born in the U.S., 47.3 years versus 41.2 years. The largest number of cases among U.S.-born
persons occurred in individuals age 45 and older, who accounted for 56% of the cases compared to 38%
in foreign-born persons (Figures 5 and 6). It is significant to note that the number of reported cases in
U.S.-born persons age 25 and older have declined from 1995 through 2000 (Figure 7). In contrast,
considerable increases were observed during the same period of time among foreign-born cases in the
15-24 and 25-44 age groups (Figure 8).

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Figure 5. TB Cases Among
U.S.-born Persons by Age Group,
Arizona, 2000

Figure 6. TB Cases Among
Foreign-born Persons by Age
Group, Arizona 2000

26%

17%

9%
4%
10%
30%
21%

1%
0-4
5-14
25-44

25-44

45-64

45-64

45%

65+

Figure 8. TB Cases Among
Foreign-born Persons by Age
Group, Arizona, 1995-2000
80

60

0-4

40

5-14

60
Count

Count

5-14
15-24

80

15-24
25-44
45-64

0-4
40

5-14

20

15-24

0

25-44
45-64

65+

19
95
19
96
19
97
19
98
19
99
20
00

19
95
19
96
19
97
19
98
19
99
20
00

0-4

15-24

Figure 7. TB Cases Among USborn Persons by Age Group,
Arizona,1995-2000

0

15%

21%

65+

20

1%

65+

Homelessness is another important risk factor for TB in Arizona with the percent of TB cases among
homeless persons in 1999 2.2 times higher than the national average of 6.3%. The percent of TB cases
among homeless persons in Arizona increased slightly in 2000 to 14.6% of cases statewide.

Nationally, the percent of TB cases diagnosed in correctional facilities decreased from 4.1% in 1995 to
3.3% in 1999. In contrast, in 2000, the percent of TB cases diagnosed in Arizona correctional facilities
increased to 8% (21) of total cases, the third highest percent of correctional TB cases reported in the U.S.
A growing challenge has been the increasing number of Immigration and Naturalization Service (INS)
detainees diagnosed with TB while in custody (15 in 2000, compared with an average of 6 per year in the
previous 3 years). Few detainees complete treatment while in custody and follow-up information is
scarce. In 2000, Arizona’s TB Control Program began actively enrolling every TB suspect who is in INS

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custody in the bi-national TB referral program, CURE-TB, offered by the San Diego TB Control Program.
It is too early to tell if this will enhance completion of therapy rates in this small but important population.

While the proportion of TB cases co-infected with HIV has been declining nationally, from 15% in 1993 to
10% in 1998, this trend is also not apparent in Arizona. In 2000, 7% of Arizona TB cases were reported
to be co-infected with HIV (Figure 9). During the years 1993 to 1998 (the last year for which national data
is available), the proportion of TB cases for which HIV results are known has increased significantly. This
increase has been much greater in Arizona (from 17% to 51%) than nationally (30% to 45%) which may
account for some of the narrowing of the gap in reported co-infection (Table 3).

Estimated HIV Coinfection in Persons Reported
with TB, U.S. and Arizona, 1993-2000

20
Percent

15
10
5
0
1993 1994 1995 1996 1997 1998 1999 2000
United States

Arizona

Table 3. Percent of TB Cases with Reported HIV Results and Percent with HIV Coinfection, U.S.
and Arizona, 1993-2000
25 – 44 Years Old
Year

HIV test results known
U.S. (%)
AZ (%)

a

All Ages
b

HIV positive
U.S. (%)
AZ (%)

HIV test results known
U.S. (%)
AZ (%)

a

b

HIV positive
U.S. (%)
AZ (%)

1993

46

38

29

19

30

17

15

7

1994

49

28

29

15

33

15

15

6

1995

52

53

26

19

36

33

13

9

1996

57

65

25

13

41

44

12

6

1997

60

69

21

10

44

45

11

4

1998

60

77

20

16

45

51

10

5

1999

84

10

60

6

2000

73

14

61

7

a

Based on reported HIV -positive status among all TB cases in the age group. Rhode Island reported HIV test results during 1998.
HIV test results were not reported from California. California did provide HIV status for TB cases in persons also reported with
AIDS.
b
Includes cases with HIV -positive test results and California cases also reported with AIDS. Percentages based on all reported TB
cases.

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Drug susceptibility
Initial drug susceptibility testing was obtained on ninety-seven percent of culture-proven TB cases in
Arizona in 2000. Overall, drug resistance patterns have not changed significantly in recent years (Table
4). However, rates of INH resistance and multi-drug resistance are significantly higher in cases among
the foreign-born, while other drug resistance patterns are generally somewhat higher among the U.S.born.

Table 4. Drug Resistance Patterns among U.S.-born and Foreign-born, Arizona, 1995-2000
INH Resistance b

Year

U.S.-born
No. (%)

Foreignborn
No. (%)

MDRc
Total
No. (%)

U.S.born
No. (%)

Foreignborn
No. (%)

a

Other Drug Resistanced
Total
No. (%)

U.S.-born
No. (%)

Foreignborn
No. (%)

Total
No. (%)

1995

2

(<1)

6

(7)

8

(3)

0

(0)

3

(4)

3

(1)

18

(12)

12

(14)

30

(13)

1996

1

(<1)

5

(6)

6

(3)

2

(1)

5

(6)

7

(3)

19

(13)

4

(5)

23

(10)

1997

8

(6)

10

(12)

18

(8)

1

(1)

1

(1)

2

(1)

17

(12)

5

(6)

22

(10)

1998

6

(5)

4

(5)

10

(5)

0

(0)

1

(1)

1

(1)

10

(8)

4

(5)

14

(7)

1999

3

(2)

4

(4)

7

(3)

0

(0)

1

(2)

2

(1)

17

(13)

9

(9)

26

(12)

2000

2

(2)

13

(10)

15

(7)

0

(0)

2

(2)

2

(1)

10

(11)

9

(7)

19

(9)

a

More than 95% of isolates had susceptibility testing performed.
Resistant to at least isoniazid without rifampin resistance.
c
Resistant to at least isoniazid and rifampin (multi-drug resistance).
d
Other drug resistance without isoniazid resistance.
b

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