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PaperclipPerfector  6d ago (text post)   23811 thread views

Culture War Roundup for the week of May 19, 2025

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Has antibiotic-resistant TB gotten that bad? Do people let TB infections get bad enough to be untreatable before seeking treatment?

These statistics from 2023 indicate that it's mostly among immigrants/non-native born people in the USA. Included with that are the risk factors associated with poverty, homelessness, and unhealthy behaviour. Plus they're including places like Guam and Micronesia, which you'd expect to have much worse outcomes anyway:

As in past years, four U.S. states combined reported half of all U.S. TB cases in 2023: California, Texas, New York (including New York City), and Florida.

...Consistent with previous years, origin of birth was a key risk factor for TB disease in 2023. Most TB cases (75.8%) in 2023 occurred among non-U.S.–born persons

...In the United States, TB disease disproportionately impacts persons who identify as members of racial or ethnic minority groups. In 2023, persons identifying as Native Hawaiian or Other Pacific Islander had the highest TB incidence rate (22.6 per 100,000 persons) among all racial/ethnic groups followed by persons identifying as Asian (14.0 per 100,000 persons).

Likewise, the U.S.-Affiliated Pacific Islands continued to report some of the highest incidence rates in the world. The TB incidence rate in 2023 was 503.7 per 100,000 persons in the Republic of the Marshall Islands and 179.4 per 100,000 persons in the Federated States of Micronesia. TB diagnoses during active case finding efforts in the Federated States of Micronesia during 2023 likely contributed to the high incidence rate there, which represents a 300.5% increase compared with 2022 (44.8 per 100,000 persons).

...TB disease in pregnancy poses a substantial risk of morbidity to both the pregnant woman and the fetus if not diagnosed and treated in a timely manner.

Smoking is associated with increased risk of TB disease.

...Living or working in congregate settings, including homeless shelters, is a risk factor for TB because shared airspace can facilitate TB exposure and transmission.

...For other risk factors, 23.4% of TB cases occurred in persons reported to have diabetes and 4.9% occurred in persons with HIV. Among persons with TB who were at least 15 years of age, social risk factors included excess alcohol use (7.9%), noninjecting drug use (7.8%), and residence within a correctional facility (3.6%) at the time of diagnosis.

...The National Vital Statistics System reported 565 TB-related deaths in 2022, the most recent year for which data are available. The TB mortality rate was 0.2 deaths per 100,000 persons. Using unrounded numbers, this represents a 6.1% decrease in the number of TB-related deaths and 6.5% decrease in the mortality rate compared with 2021.

As regards drug resistance:

...Isoniazid (INH) drug-resistant and multidrug-resistant (MDR) TB disease Organisms resistant to one of the most common anti-TB drugs, isoniazid (INH), cause INH-resistant TB disease. Multidrug-resistant (MDR) TB disease is caused by an organism that is resistant to at least isoniazid and rifampin. In Tables 12–14, INH-resistant and MDR cases are displayed by year and stratified by a patient’s history of previous TB disease.

Starting in 2023, information on drug resistance included results of molecular drug susceptibility testing in addition to growth-based susceptibility testing for isoniazid and rifampin. An isolate was considered resistant to isoniazid or rifampin if either the growth-based test or molecular test detected resistance.

So at a glance it looks like "be immigrant, be poor/in bad circumstances, don't get diagnosed immediately, don't get put on treatment immediately, more likely to contract TB and to die from it". Again, drug-resistant TB seems to be slightly higher amongst non-US born than US natives. And smoking/vaping is the big risk factor.

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