Recent rates of active respiratory tuberculosis (TB) in the United States are suggested to reflect immigration patterns from endemic areas, with highest rates in the West and South United States, according to new data presented at the American College of Chest Physicians (CHEST) 2025 Annual Meeting. 

Slightly more than half of the patients (52.7%) resided in densely populated metropolitan areas, and the highest rates corresponded to zip codes with the lowest median household income, the researchers noted. 

The recent demographics of active respiratory TB observed in the current study likely reflect immigration trends of living in dense urban areas with a lower median income, the researchers wrote. “Public health policy directives to address screening and outpatient treatment of tuberculosis could potentially reduce costly inpatient admissions,” they concluded.

TB is uncommon in the US, but data on demographics and outcomes of those hospitalized with TB across the US in recent years are lacking,

according to Thai Truong, MD, of St Barnabas Hospital, Bronx, New York, and colleagues. 

In their study, the researchers reviewed data from the National Inpatient Sample from 2016 to 2022 on all admissions with active respiratory TB as a principal diagnosis. Demographic information included race, gender, mean age, geographic location, residence, and the median household income for the patient’s ZIP code.

The analysis included 4752 hospital admissions for active respiratory TB, with a mean patient age of 50.22 years; 68.10% were men. 

The primary outcomes were in-hospital mortality, hospital length of stay, and the need for intubation. 

The mean hospital stay was 16.22 days, longer among males vs females (17.32 vs 13.88 days; P < .001), and in-hospital mortality was associated with a significantly longer mean hospital stay (21.31 vs 16.10 days; P = .0093).

Rates of intubation and mortality rate were approximately 2% for both genders, but those who needed intubation had significantly higher mortality overall (47.52% vs 1.59%) and were significantly older than non-intubated patients (62 vs 50 years; P < .001 for both). 

The largest proportion of respiratory TB patients were Hispanic (30.85%), followed by Asian and Pacific Islander (21.03%), Black (20.09%), White (17.87%), other (8.84%), and Native American (1.33%) patients. Respiratory TB rates were highest in the Pacific region (27.20%), followed by the South Atlantic, Middle Atlantic, and West South Central regions (17.64%, 16.73%, and 14.83%, respectively). 

The researchers also examined the mean total charge during hospital stay, which was $120,185.3; approximately 60% was paid by Medicare or Medicaid. 

The high hospital charges and long hospital stays (mean of more than 2 weeks) for each TB admission were surprising, Truong told Medscape Medical News. One possible reason for prolonged hospitalization is that many patients are required to stay until public health agencies can find a safe place to discharge them to prevent community spread of TB, Truong said. Additionally, some patients with complicated TB may require longer hospital care, Truong noted. 

Takeaways and Next Steps

The study findings emphasize the importance of screening and latent TB treatment programs for high-risk populations to reduce costs of hospital admissions and prevent the spread of disease, said Truong. 

“Another important result from our study is that we did not find any resistant TB cases during the study period,” said Truong. “We are uncertain whether that is accurate, or whether the sensitivity results came back after patients were discharged, so the database did not capture the resistant TB cases in the sample, and more research on hospital databases are needed to investigate this issue,” Truong added.

Foundation for Future Research 

The CDC estimates that 13 million people in the US have latent TB, said Eric Altneu, MD, an assistant professor of clinical medicine at the Lewis Katz School of Medicine at Temple University, Philadelphia, in an interview. 

Rates of TB had been declining for 30 years, but increased again starting in 2021, as the current study indicates, said Altneu, who was not involved in the study. 

“This study elucidated demographic trends in respiratory tuberculosis cases nationally that mirrored previous summaries,” Altneu said. The study identified Hispanic and Asian and Pacific Islander individuals as the two highest groups with respiratory TB in the United States, and the 2023 Executive Summary from the CDC’s tuberculosis surveillance report has previously identified these populations as disproportionately impacted,” Altneu noted. “An important piece of data was that patients with the lowest median household income (based on ZIP code) had the highest rates of active TB,” added Altneu. This finding, while not surprising, demonstrates the known disparity of worse health outcomes among individuals with lower socioeconomic status, he said. 

The current study highlights the importance of keeping TB on the differential diagnosis list for patients in all clinical settings to speed early identification and treatment, Altneu told Medscape Medical News. “Patients with respiratory tuberculosis may require extended inpatient stays as well,” he noted. “These large database studies are excellent jumping off points for further research,” said Altneu. Analyses of data from the past few years regarding TB rates, with more granular detail on comorbidities and risk factors for acquisition, would be useful, he said.

The study received no outside funding. The researchers had no financial conflicts to disclose. Altneu had no financial conflicts to disclose.