Abstract
BACKGROUND: There were limited data on tuberculosis (TB) epidemiology and outcomes among older adults in the United States. We analyzed TB epidemiology and outcomes among New York City residents to identify opportunities for prevention and improved outcomes among older adults. METHODS: We used New York City TB surveillance data to describe TB incidence, patient characteristics, and treatment outcomes comparing older (≥65 years) and younger (18-64 years) adults. Cox proportional hazard models were used to assess characteristics associated with death. RESULTS: During 2001-2022, overall TB incidence declined from 18 to 7 cases per 100 000 population. Of 5577 TB cases during 2011-2020, 1360 (24%) were among older adults. Among older adults with TB, 86% were born outside the United States (median of 24 years in United States at diagnosis), 8% had lived in long-term care facilities, and 5% died before starting TB treatment. Hazard ratio (HR) of death among adults aged 65-74 years during TB treatment was 7.19 (95% confidence interval [CI], 4.56-11.34) compared to adults aged 18-44 years. Among older adults, those with a history of living in long-term care (HR, 2.57; 95% CI, 1.74-3.80) or hepatitis B or C (HR, 1.86; 95% CI, 1.09-3.15) had a higher hazard of death during treatment. CONCLUSIONS: Efforts to prevent TB among older New Yorkers by identifying and treating latent TB could focus on long-term care facility residents. Educating providers regarding early diagnosis of TB and comorbidities associated with poor treatment outcomes might help prevent onward transmission and TB-associated mortality in this age group.