LONG-TERM TRENDS IN TUBERCULOSIS-RELATED MORTALITY IN THE US AMONG OLDER ADULTS (AGES 35+): A 22-YEAR CDC WONDER ANALYSIS (1999-2020)

MIAN ZAHID JAN KAKAKHEL; IQRA Khan; RAMEEZ Qasim; BASSEL Alrabadi; MARIO Gonzalez; ABDUL Qadeer; MUHAMMAD USMAN Haider; HASAN Ilyas; ISHTIAQ Ahmad

doi:10.1016/j.chest.2025.07.680

PURPOSE: Tuberculosis remains a serious public health concern in older adults, yet long-term mortality trends in the U.S. are not well documented. This study analyzes national data from 1999 to 2020 to assess tuberculosis-related mortality in individuals aged 35 years and older, examining age, sex, racial, and geographic disparities. By identifying demographic and temporal patterns, the findings aim to guide public health policies and interventions to reduce mortality and improve outcomes in high-risk pediatric populations. METHODS: Using CDC WONDER data, we calculated Age-Adjusted Mortality Rates (AAMR) per 100,000 individuals aged 35 years and older, who died from tuberculosis-related conditions. Primary Cause of Death (UCD) analysis included respiratory tuberculosis (A15), bacteriologically and histologically negative respiratory tuberculosis (A16), tuberculosis of the nervous system (A17), other tuberculosis affecting bones, joints, or the genitourinary system (A18), and miliary tuberculosis (A19). Age-stratified trends were analyzed in twenty-year increments (35-54, 55-74, 75+). Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC) from 1999 to 2020. RESULTS: From 1999 to 2020, TB-related mortality in the adult population declined, with AAMR decreasing from 0.62 to 0.37 (AAPC: -3.4, 95% CI: -4.1 to -2.7). A total number of 12,862 deaths were recorded during this period. Males consistently had higher AAMRs (overall AAMR: 0.47) than females (overall AAMR: 0.22). Racial disparities were evident, with NH Asian or Pacific Islanders having the highest overall AAMR (1.44) followed by American Indian or Alaskan Natives (1.17), NH Black or African American (0.75), Hispanics or Latinos (0.62), NH White (0.23). Mortality rates were higher in urban areas (overall AAMR: 0.37) than in rural areas (overall AAMR: 0.28). Age-specific trends indicated significant increases in mortality rates across all age groups, with the +75 years age group showing the highest Crude Rate Mortality (1.40). AAMR also varied substantially by region (overall AAMR: West: 0.46; Northeast: 0.29; South: 0.38; Midwest: 0.24). CONCLUSIONS: Despite an overall decline in tuberculosis-related mortality from 1999 to 2020 in adults aged 35 and older, significant disparities persist across sex, race, and geographic location. Males, NH Asian or Pacific Islanders, and American Indian or Alaskan Native populations exhibited the highest mortality rates. Regional differences, with higher AAMRs in the West and South, emphasize the need for targeted public health efforts. CLINICAL IMPLICATIONS: These findings highlight the importance of early diagnosis, vaccination, and access to specialized TB care among older adults, particularly in high-risk groups. Strengthening surveillance, expanding outreach programs in urban areas, and addressing racial and regional disparities can help further reduce pediatric TB mortality and improve long-term health outcomes.

LONG-TERM TRENDS IN TUBERCULOSIS-RELATED MORTALITY IN THE US AMONG OLDER ADULTS (AGES 35+): A 22-YEAR CDC WONDER ANALYSIS (1999-2020)

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