An Unanswered Health Disparity: Tuberculosis Among Correctional Inmates,1993 Through 2003

Jessica R. MacNeil; Mark N. Lobato, MD; Marisa Moore, MD, MPH


Am J Public Health. 2005;95(10):1800-1805. 

In This Article

Abstract and Introduction

Objectives: We sought to describe disparities and trends in tuberculosis (TB) risk factors and treatment outcomes between correctional inmate and noninmate populations.
Methods: We analyzed data reported to the national TB surveillance system from 1993 through 2003. We compared characteristics between inmate and noninmate men aged 15-64 years.
Results: Of the 210 976 total US TB cases, 3.8% (7820) were reported from correctional systems. Federal and state prison case rates were 29.4 and 24.2 cases per 100 000 inmates, respectively, which were considerably higher than those in the noninmate population (6.7 per 100 000 people). Inmates with TB were more likely to have at least 1 TB risk factor compared with noninmates (60.1% vs 42.0%, respectively) and to receive directly observed therapy (65.0% vs 41.0%, respectively); however, they were less likely to complete treatment (76.8% vs 89.4%, respectively). Among inmates, 58.9% completed treatment within 12 months compared with 73.2% of noninmates.
Conclusions: Tuberculosis case rates in prison systems remain higher than in the general population. Inmates with TB are less likely than noninmates to complete treatment.

Tuberculosis (TB) is an important health problem in correctional systems in many parts of the United States. Although the incident TB case rate for the general population has remained at fewer than 10 cases per 100000 persons since 1993,[1] substantially higher case rates, some as high as 10 times that of the general population, have been reported in correctional populations.[2,3,4] The TB case rate reported from 1 urban jail was 72.1 cases per 100000 inmates, representing 10% of the county's cases.[5] Furthermore, studies have found the prevalence of latent TB infection (LTBI) among inmates to be as high as 25%.[6,7,8,9,10] Other studies have shown a correlation between length of incarceration and positive tuberculin skin test responses, indicating transmission may have occurred in these facilities.[11,12]

A disproportionately high percentage of TB cases in the United States occur among persons incarcerated in correctional facilities. In 2003, 3.2% of all TB cases nationwide occurred among residents of correctional facilities.[1] In contrast, 0.7% of the total US population were confined in prisons and jails in 2003, a population that was increasing at an average annual rate of 3.7% from 1995 through 2003.[13] One notable reason for the high rates of TB in correctional institutions is the greater proportion of persons who are at high risk for TB but who can not access standard public health interventions. Transmission risks particular to correctional institutions include close living quarters, poor ventilation, and overcrowding.[5,14,15]

Owing to the occurrence of TB outbreaks and the documentation of high rates of TB in correctional systems, the Centers for Disease Control and Prevention (CDC), in 1993, began asking state health departments to report whether those newly diagnosed with TB were residents of correctional facilities. We analyzed data reported to the national TB surveillance system from 1993 through 2003 to define trends in correctional TB cases and describe characteristics of individuals with TB who are residents of correctional facilities.