摘要：Objectives. We investigated tuberculosis (TB) incidence rates and characteristics of patients with TB in large US cities. Methods. Using the Centers for Disease Control and Prevention's National Tuberculosis Surveillance System data, we categorized 48 cities annually from 2000 to 2007 as reporting decreasing or nondecreasing rates with Joinpoint analysis. We compared demographic, clinical, and treatment characteristics of patients with TB using bivariate and multivariate analyses. Results. We found that 42 448 patients with TB in 48 cities accounted for 36% of all US patients with TB; these cities comprised 15% of the US population. The average TB incidence rate in the 48 cities (12.1 per 100 000) was higher than that in the US excluding the cities (3.8 per 100 000) but decreased at a faster rate. Nineteen cities had decreasing rates; 29 cities had nondecreasing rates. Patient characteristics did not conclusively distinguish decreasing and nondecreasing rate cities. Conclusions. A significant TB burden occurs in large US cities. More than half (60%) of the selected cities did not show decreasing TB incidence rates. Studies of city-level variations in migration, socioeconomic status, and resources are needed to improve urban TB control. In the next 30 years, nearly two thirds of the world's population is expected to live in urban areas. 1 Recent publications have emphasized important issues related to urban health, such as population composition, physical and social environment, and availability and access to health services. 2 – 5 In terms of health outcomes, the most urban and rural areas are often considerably disadvantaged compared with suburban areas. 6 Tuberculosis (TB) has been called a social disease. 7 Social conditions affecting urban areas such as homelessness or those that create other marginalized populations—such as the HIV epidemic, high population density, suboptimal access to health care, and declining public health infrastructures—have been closely associated with TB. 8 – 13 In addition, the migration of people from highly endemic countries from rural areas to cities and urban areas in low-incidence countries has increasingly affected urban TB incidence rates. 14 – 16 In a study of European cities surveyed from 1999 to 2000, 27 of 29 cities reported TB incidence rates higher than their respective national averages. 17 A study in Denmark found that TB incidence rates in urban areas were twice as high as were incidence rates in rural areas. 18 During and after the 1990s TB resurgence in the United States, TB incidence rates in New York City were 4 times the US national average, with central Harlem experiencing rates 20 times the national average. 19 Although TB incidence rates have declined overall in the United States since the mid-1990s, urban areas remain a focus for TB control. 13 We examined TB epidemiology in large cities in the United States, using national data from 2000 to 2007 to document patient characteristics associated with urban TB. Furthermore, we evaluated trends in TB incidence case counts and incidence rates and determined characteristics of patients with TB in cities with decreasing versus nondecreasing TB incidence rates from 2000 to 2007.
