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


An inmate TB patient was defined as a person who was incarcerated in a correctional facility at the time TB was diagnosed. We analyzed data from TB cases reported to the national TB surveillance system from 1993 through 2003 among inmates of correctional systems (including federal and state prisons, local jails, and juvenile facilities, and other facilities such as immigration detention centers) in the 50 states and the District of Columbia. For comparative purposes, all calculations and comparisons for risk-factor characteristics, clinical presentation, drug resistance, and treatment outcomes were performed only for males aged 15 to 64 years, a group that comprised 85.5% of inmate cases.

Variables in the national TB case report are collected uniformly throughout the country with the exception of human immunodeficiency virus (HIV) status. California does not report individual HIV test results but does submit the results of TB and AIDS registry cross-matches. California TB patients with an AIDS match were classified as HIV-infected; all others were classified as having an unknown HIV status. All 2003 California cases are classified as unknown HIV status.

Completion-of-therapy calculations were done for persons who were alive at diagnosis, had an initial drug regimen of 1 or more anti-TB drugs, did not die during therapy, and did not have an initial Mycobacterium tuberculosis isolate resistant to rifampin. Timely completion of therapy was defined as completion of treatment within 12 months. The latest year for which information on treatment outcomes is available is 2001.

State and federal prison population case rates were calculated with data from the US Bureau of Justice Statistics.[13,16,17] Estimates of correctional populations are based on year-end counts of inmates for state and federal prisons in the 50 states, the District of Columbia, and the Federal Bureau of Prisons. Case rates were not calculated for jail inmates because accurate estimates for this population were not available, in part owing to the difficulty of removing recidivists from the population count.