Tuberculosis Surveillance Report
Arizona, 2002

Arizona Department of Health Services
Bureau of Epidemiology and Disease Control
Office of Infectious Disease Services
May 2003

Tuberculosis Control Program
3815 N Black Canyon Highway
Phoenix, Arizona 85015
602 230-5936

EXECUTIVE SUMMARY
There were 263 cases of active tuberculosis (TB) reported in Arizona in 2002, representing a
9% decrease in the number of cases compared to 2001, but a 1.5% increase in the number of
cases since 1992. While the number of TB cases fluctuates from year to year, there has been
no consistent trend downward during the past 10 years. TB case rates, however, have been
declining during this same period due to an increasing population. The rate of TB in Arizona
declined to 4.8 cases per 100,000 persons in 2002, an 11% decrease since 2001 and a 28%
decrease since 1992. This places Arizona 39th by percentage change in case rate during the
period 1992-2002 among 50 states and the District of Columbia. The United States (U.S.) case
rate in 2002 was 5.2 cases per 100,000, which represents a 7% decrease since 2001 and a
50% decrease since 1992 (Table 1 and Figure 1). The majority of TB cases (59%) in Arizona in
2002 occurred in working age adults (25-64 years) with a mean age of 44.5 years and median
age of 44 years, with males accounting for 65% of cases (n=170). The breakdown by
race/ethnicity is 55% Hispanic, 19% white, non-Hispanic, 14% Native American, 7% Asian and
6% black, non-Hispanic. The TB case rate for Hispanics is 10.4 cases per 100,000, more than
double the rate for all races in Arizona, additionally, 78% of pediatric (<5 years) TB cases in
2002 occurred among Hispanics (Table 2 and Figure 3). The occurrence of TB in young
children represents ongoing transmission in the community and is an indicator of efficacy of TB
program activities. The percentage of TB cases in young children (<5 years) has not declined in
Arizona since 1993, with an average of 3.9% of TB cases occurring in children less than five
years for the period 1993 to 2002.
Total resistance to the anti-TB drug isoniazid (INH) was 5.3% in 2002. Drug resistance patterns
vary greatly by country of origin with 1.0% of U.S.-born persons resistant to at least INH without
rifampin (RIF) resistance compared to 8.1% of foreign-born persons. Persons resistant to at
least INH and RIF (multi-drug resistant) accounted for only 0.5% of Arizona TB cases in 2002.
All multi-drug resistant TB cases in the past five years in Arizona have been foreign-born (Table
4). Foreign-born persons accounted for 52% of Arizona TB cases in 2002 with Mexico listed as
the country of birth for 76% of foreign-born cases. Persons from Asian countries contributed an
additional 13% of foreign-born cases (Figure 4 and Figure 5). Other important risk factors
identified among Arizona TB cases in 2002 are, excess alcohol use (14.8%), homelessness
within the past year (11.0%), non-injecting drug use (9.1%), residence in a correctional facility
(7.2%), HIV coinfection (6.5%) and injecting drug use (3.8%). Among persons in the 25-44 year
age group, 14.3% of TB cases were coinfected with HIV (Table 5). Maricopa County accounted
for 65% (n=172) of 2002 TB cases; other high morbidity counties include Pima 9% (n=24), Pinal
5% (n=14) and Yuma 5% (n=14). Apache County had the highest case rate in 2002 (14.3
cases/100,000), followed by Navajo County (8.9 cases/100,000), Yuma County (8.2
cases/100,000) and Pinal County (7.3 cases/100,000) (Figure 6).

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Table 1. Tuberculosis Cases and Case Rates per 100,000 Population, Arizona and United
States, 1992 - 2002
a
Arizona
United States
b
c
Rate
Cases
Rate
Cases
Year
Population
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002

259
228
247
317
282
296
254
262
261
289
263

3,858,825
3,946,975
4,036,875
4,184,723
4,462,717
4,595,379
4,722,097
4,924,350
5,130,632
5,307,331
5,472,750

6.7
5.8
6.1
7.6
6.3
6.4
5.4
5.3
5.1
5.4
4.8

26,673
25,287
24,361
22,860
21,337
19,851
18,361
17,531
16,377
15,989
15,078

10.5
9.8
9.4
8.7
8.0
7.4
6.8
6.4
5.8
5.6
5.2

a

Data from U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, available at:
www.cdc.gov/nchstp/tb/
b
Year reported reflects the year case was verified by Arizona Department of Health Services.
c
Population denominators for 2001 and 2002 are estimates from the Arizona Department of Economic Security
(http://www.de.state.az.us/links/economic/webpage/popweb/EEC-02.pdf). Year 2000 denominators are from the 2000 U.S.
Census. Population projections from Arizona Department of Economic Security are used for years prior to 2000.

Figure 1. Tuberculosis Case Rates per 100,000 Population,
Arizona and United States, 1992 - 2002
12
10
8
6
4
2
0
1992

1993

1994

Arizona

1995

1996

1997

United States

Page 3 of 7

1998

1999

2000

2001

2010 Target (1/100,000)

2002

Figure 2. Age Group by Race/Ethnicity, Arizona, 2002

Number of Cases

60
50
40
30
20
10
0
0-4

5-14

Asian

15-24

Black

25-44

Hispanic

45-64

Native American

65+

White

Table 2. Tuberculosis Cases by Ethnicity, Gender and Age Group, Arizona, 2002
Age Group
15-24 25-44

<5

5-14

0
2
2

0
1
1

1
1
2

0
0
0

0
0
0

Male
Female
Total
d
Native American

3
4
7

Male
Female
Total
e
Asian
Male
Female
Total
Total by Gender
Male
Female
Total by Age Group
No.
(%)

White, Not Hispanic
Male
Female
Total
Black, Not Hispanic
Male
Female
Total
c
Hispanic or Latino

Rate

a,b

Total by Ethnicity
No.
(%) Ratea,b

45-64

65+

6
4
10

18
1
19

8
8
16

33
17
50

(19.0)

1.4

1
0
1

6
3
9

0
1
1

3
1
4

10
5
15

(5.7)

8.9

3
9
12

14
5
19

43
14
57

21
11
32

9
8
17

93
51
144

(54.8)

10.4

0
0
0

0
0
0

0
0
0

4
0
4

11
5
16

9
7
16

24
12
36

(13.7)

13.2

0
0
0

0
0
0

2
3
5

3
1
4

1
2
3

4
2
6

10
8
18

(6.8)

17.1

3
6

3
10

18
9

62
22

51
20

33
26

170
93

(64.6)
(35.4)

6.2
3.4

9
(3.4)
2.2

13
(4.9)
1.6

27
(10.3)
3.5

84
(31.9)
5.2

71
(27.0)
6.2

59
(22.4)
8.3

263

a

(100.0)

Rate per 100,000 population.
Population denominators for 2002 are estimates from the Arizona Department of Economic Security .
c
Persons of Hispanic or Latino origin may be of any race.
d
Includes American Indians and Native Alaskans.
e
Includes Native Hawaiians and Other Pacific Islanders.
b

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4.8

Figure 3. Percentage of Total Tuberculosis Cases and Case Rates by
Ethnicity, Arizona, 2002
20
17.1

Percentage

50
40

13.2
8.9

30
20

15

10.4

10
5

1.4

10
0

Cases
per 100,000

60

0
Asian

Black

Hispanic

Percentage

Native
American

White

Rate

Table 3. Tuberculosis Cases by Form of Disease and Vital Status at Diagnosis,
Arizona, 2002
Alive at Diagnosis

Form of Disease

No.

a

Pulmonary

b

Extrapulmonary
Cases with Both Pulmonary and
c
Extrapulmonary Disease
Total (%)

Diagnosis After Death

(%)

No.

Total Cases
No.

(%)

188

5

193

(73.4)

41

4

45

(17.1)

24

1

25

(9.5)

253 (96.2)

10

(%)

(3.8)

263 (100.0)

a

Includes cases with pulmonary listed as major site of disease and no additional site of disease.
Includes cases with pleural, lymphatic, bone and/or joint, meningeal, peritoneal, or other site, excluding pulmonary, listed
as the major site of disease.
c
Includes miliary cases.
b

Table 4. Drug Resistance Among U.S.-born and Foreign-born Tuberculosis Cases, Arizona,
1998-2002
INH Resistance
Year

U.S.-born

Foreignborn

No. (%) No.

(%)

a,b

Multi-Drug Resistant
Total

e

U.S.-born

Foreignborn

a,c

Total

Other Drug Resistance
e

U.S.-born

No. (%) No. (%) No. (%) No. (%) No.

(%)

Foreignborn
No.

(%)

a,d

Total
No.

e

(%)

1998

6 (4.8)

4

(5.0)

10 (4.9)

0 (0.0)

1 (1.3)

1 (0.5)

10

(8.0)

4

(5.0)

14

1999

2 (1.5)

4

(4.3)

6 (2.7)

0 (0.0)

2 (2.2)

2 (0.9)

18 (13.6)

9

(9.7)

27 (12.0)

2000

2 (2.1)

13 (10.5)

15 (6.8)

0 (0.0)

2 (1.6)

2 (0.9)

10 (10.4)

9

(7.3)

19

(8.6)

9

(8.8)

18

(8.0)

2001

4 (3.3)

5

(4.9)

9 (4.0)

0 (0.0)

3 (2.9)

3 (1.3)

9

(7.4)

2002

1 (1.0)

9

(8.1)

10 (4.8)

0 (0.0)

1 (0.9)

1 (0.5)

7

(7.3)

a

More than 95% of isolates had susceptibility testing performed.
Resistance to at least isoniazid without rifampin resistance.
c
Resistance to at least isoniazid and rifampin (multi-drug resistance).
d
Other drug resistance without isoniazid resistance.
e
Includes persons of unknown country of birth.
b

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14 (12.6)

(6.8)

22 (10.6)

Figure 5. Reported Country of
Birth, Arizona TB Cases, 2002

Figure 4. Foreign-Born TB Cases,
Arizona, 1993 - 2002
100%

Philippines

80%

Vietnam

60%

U.S.

40%

Foreign

India

Mexico
76%

China
Other

20%

19
9
19 3
9
19 4
9
19 5
9
19 6
9
19 7
9
19 8
9
20 9
0
20 0
0
20 1
02

0%

Table 5. Tuberculosis Cases by Selected Risk Factors, Arizona, 1998 - 2002
1998
No.

1999

(%)

No.

(%)

2000
No.

(%)

2001
No.

(%)

2002
No.

(%)

Occupation
Correctional Facility Worker

1 (0.4)

0 (0.0)

0 (0.0)

0 (0.0)

0 (0.0)

Health Care Worker

3 (1.2)

1 (0.4)

6 (2.3)

5 (1.7)

3 (1.1)

Migrant Farm Worker

5 (2.0)

6 (2.3)

9 (3.4)

6 (2.1)

8 (3.0)

Reported Behaviors
a

6 (2.4)

10 (3.8)

11 (4.2)

11 (3.8)

11 (4.2)

10 (3.9)

20 (7.6)

20 (7.7)

22 (7.6)

25 (9.5)

39 (15.4)

55 (21.0)

46 (17.6)

61 (21.1)

39 (14.8)

4 (1.6)

7 (2.7)

7 (2.7)

12 (4.2)

8 (3.0)

14 (5.5)

18 (6.9)

21 (8.0)

16 (5.5)

19 (7.2)

Homeless
Country of Birth

29 (11.4)

36 (13.7)

39 (14.9)

46 (15.9)

28 (10.6)

c

100 (39.4)

109 (41.6)

147 (56.3)

133 (46.0)

136 (51.7)

14 (5.5)

16 (6.1)

18 (6.9)

12 (4.2)

17 (6.5)

Injecting Drug Use

Non-injecting Drug Use
Excess Alcohol Use
Type of Residence

a

a

b

Long Term Care Facility
b

Correctional Facility
a

Foreign Born
Underlying Disease
HIV infection, All Ages

d

HIV infection, 25-44 Years Old
Total Cases

d

11 (15.9)
254

10 (10.1)
262

13 (14.3)
261

8 (9.0)
289

12 (14.3)
263

a

Within one year prior to diagnosis of tuberculosis.
Residence at time of diagnosis.

b
c

Includes persons born outside the United States and its territories.

d

Tuberculosis cases with a reported positive HIV test result. The percent positive represents HIV co-infection among all verified TB
cases, including those not tested for HIV infection.

Page 6 of 7

Figure 6. Tuberculosis Cases and Case Rates per 100,000 (in parentheses) by County,
Arizona, 2002.

The Tuberculosis Surveillance Report is published annually by the Arizona Department of
Health Services, Tuberculosis Control Section. All data are provisional. Report finalized on
5/6/2003 based on data available 3/24/2003.

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