Tuberculosis in Older Adults in the United States, 1993-2008

OBJECTIVES: To describe older adults with tuberculosis (TB) and compare demographic, diagnostic, and disease characteristics and treatment outcomes between older and younger adults with TB. DESIGN: Descriptive analysis of all confirmed people with TB aged 21 and older. SETTING: The National Tuberculosis Surveillance System (NTSS) for the 50 United States and the District of Columbia from 1993 to 2008. PARTICIPANTS: A total of 250,784 adult TB cases were reported, including 61,119 people with TB aged 65 and older. MEASUREMENTS: TB case count and rates and proportion of TB cases in older adults. RESULTS: Older adults had consistently higher incidence rates of TB than younger adults. In 2008, the rate of TB in older adults was 6.4 per 100,000, compared with 5.0 per 100,000 for younger adults. A lower percentage of older adults had TB diagnostic test results (tuberculin skin test, sputum smear, sputum culture) or human immunodeficiency virus (HIV) infection status reported. TB risk factors (substance use, homelessness, HIV infection) and multidrug-resistant TB were less prevalent in older than younger adults. Seven percent of older adults were dead at diagnosis, and 21% died during therapy, compared with 2% and 7%, respectively, of younger adults. Sputum culture conversion percentages were similar for people who did not die. Older adults also completed therapy in a timely manner, similar to younger adults. CONCLUSION: Although older adults had higher rates of TB and mortality, for older adults who survived therapy, successful treatment outcomes were similar to those of younger adults. J Am Geriatr Soc 59:851-857, 2011.