IDPS HomeInfectious Diseases A-CD-GH-LM-QR-ST-ZHealthcare SafetyVaccine Preventable DiseasesIDPS Health TopicsImmunization UnitDisease ReportingAbout IDPSRelated DSHS SitesRelated Rules & Regulations
  • Contact Us

    TB and Hansen's Disease Branch

    MC 1939
    P.O. Box 149347
    Austin, TX 78756-9347

    Phone:
    Fax: 512-533-3167


    Email the TB Program

Epi Profile Section 7 - Risk Factors Associated with Tuberculosis


Risk factors among people diagnosed with TB have remained consistent from 2013 to 2017. Approximately a third of the total cases reported more than one risk factor for tuberculosis.

Table 7 Risk Factors Among TB Cases by Reporting Year
Risk Factor

2013

2014

2015

2016

2017

Total

Non-US Born

55.2%

60.4%

57.9%

59.1%

61.1%

58.7%

Diabetes

18.7%

20.0%

18.1%

18.6%

18.9%

18.9%

Alcohol Abuse

17.5%

16.9%

16.6%

15.0%

11.5%

15.6%

Corrections*

9.8%

11.5%

11.4%

11.6%

8.3%

10.6%

Non-Injection Drug Use

10.4%

10.1%

9.7%

8.6%

8.3%

9.5%

HIV Positive

6.6%

5.2%

5.7%

5.5%

6.5%

5.9%

Homelessness

6.9%

5.0%

6.7%

5.1%

3.5%

5.5%

Injection Drug Use

2.9%

3.5%

2.6%

1.8%

1.2%

2.4%

Total

1,221

1,269

1,333

1,250

1,127

6,200

*Diagnosed in a correctional facility


Table 8 Cases with Multiple Risk Factors for TB by Reporting Year
Risk Factors Reported

2013

2014

2015

2016

2017

Total

0

21.6%

19.4%

20.4%

19.0%

20.1%

20.1%

1

41.8%

44.4%

43.1%

47.4%

47.5%

44.7%

>1

36.6%

36.6%

36.5%

33.5%

32.4%

35.2%

Total

1,221

1,269

1,333

1,250

1,127

6,200


Persons with Diabetes Mellitus

  • In 2017, 18.9% of Texas TB cases reported also having diabetes mellitus compared to 19.9% of US cases overall.
  • TB cases with comorbid diabetes are likely to experience treatment complications.  This is the most common comorbidity reported in Texas.
  • Texas TB cases with comorbid diabetes have 1.85 times higher risk of dying from TB compared to non-diabetic cases.

Persons with Human Immunodeficiency Virus (HIV)

  • Persons with HIV have a weakened immune system and can progress more rapidly from TB infection to active TB disease.
  • The 2017 TB case rate among Texans living with HIV is estimated at 80.5 per 100,000 and is 20 times higher than the state rate.
  • In 2017, 6.5% of Texas TB cases were HIV-positive compared to 5.5% of US TB cases.
  • 86% of 2017 Texas cases had an HIV test result reported.

Persons with reported substance abuse

  • For 2017, 11.5% of Texas TB cases reported alcohol abuse, 8.3% reported non-injection drug use, and 1.2% reported injection drug use. For the US overall these proportions were 8.9%, 6.7%, and 1.2% respectively.
  • TB cases with reported alcohol abuse have 2.05 times the risk of death related to TB compared to cases with none. They also have 2.15 times the risk of being reported as lost to follow up compared to other cases.
  • TB cases with reported injection drug use have a 2.55 higher risk of death related to TB compared to cases without drug use. They also have 3.8 times the risk of becoming lost to follow up and not finishing TB medication.
  • TB cases with reported non-injection drug use have a 3.10 higher risk of being reported as lost to follow up and not finishing TB medication compared to cases with none.
  • There is a higher probability of reported substance abuse among cases who are HIV-positive, cases experiencing homelessness, and cases that were reported from a correctional facility. Substance abuse may contribute to poorer treatment outcomes for these cases.

 

Figure 4 Proportion of Substance Abuse* Among TB Cases in Texas, 2017

Figure 4 Proportion of Substance Abuse* Among TB Cases in Texas, 2017. Data linked below.

*Defined as alcohol abuse, injection drug use, and non-injection drug use.

Data in Figure 4

 

Persons experiencing homelessness

  • The 2017, TB case rate among Texans experiencing homelessness is estimated at 169.9 per 100,000, is 42.5 times higher than the state rate, and 60 times higher than the US rate.
  • In 2017, 3.5% of Texas TB cases reported homelessness compared to 4.3% of US cases.
  • Various factors, such as population mobility and shelter conditions, increase the potential for TB to spread within this population and those that serve them.
  • TB cases experiencing homelessness have a 2.69 higher risk of dying of TB compared to those who are not.  TB cases experiencing homelessness also have 4.27 times the risk of being reported as lost to follow up and not finishing TB medications compared to cases not reporting homelessness.

Incarcerated persons

  • In 2017, 8.3% of Texas TB cases were reported from a correctional facility compared to 3.1% of US cases.[2]
  • The high turnover of offenders, the frequent movement of offenders within and between correctional facilities, and the conditions of the correctional facilities can increase the potential for TB to spread within this population and those that serve them.
  • TB cases reported from correctional facilities have 5.65 times higher risk of being reported as lost to follow up and not finishing their TB medications compared to cases who were not incarcerated.

 

[2] Centers for Disease Control and Prevention (CDC). Reported Tuberculosis in the United States, 2017. Atlanta, GA: US Department of Health and Human Services, CDC; 2019.


 


Table of Contents | An Overview of Tuberculosis in Texas | Distribution of Tuberculosis in Texas | Affected Populations | Case Diagnosis | Recent Transmission | Mortality | Risk Factors Associated with Tuberculosis | Drug Resistant TB | Targeted Testing | Reporting Requirements | References


Last updated June 25, 2019