Comparing drivers and dynamics of tuberculosis in California, Florida, New York, and Texas

Sourya Shrestha, Andrew N. Hill, Suzanne M. Marks, David W. Dowdy

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Rationale: There is substantial state-to-state heterogeneity in tuberculosis (TB) in the United States; better understanding this heterogeneity can inform effective response to TB at the state level, the level at which most TB control efforts are coordinated. Objectives: To characterize drivers of state-level heterogeneity in TB epidemiology in the four U.S. states that bear half the country'sTB burden: California, Florida, New York, and Texas. Methods: We constructed an individual-based model of TB in the four U.S. states and calibrated the model to state-specific demographic and age- and nativity-stratified TB incidence data. We used the model to infer differences in natural history of TB and in future projections of TB. Measurements and Main Results: We found that differences in both demographic makeup (particularly the size and composition of the foreign-born population) and TB transmission dynamics contribute to state-level differences in TB epidemiology. The projected median annual rate of decline in TB incidence in the next decade was substantially higher in Texas (3.3%; 95% range, -5.6 to 10.9) than in California (1.7%; 95% range, -3.8 to 7.1), Florida (1.5%; 95% range, -7.4 to 14), and New York (1.9%; 95% range, -6.4 to 9.8). All scenarios projected a flattening of the decline in TB incidence by 2025 without additional resources or interventions. Conclusions: There is substantial state-level heterogeneity in TB epidemiology in the four states, which reflect both demographic factors and potential differences in the natural history of TB. These differences may inform resource allocation decisions in these states.

Original languageEnglish (US)
Pages (from-to)1050-1059
Number of pages10
JournalAmerican journal of respiratory and critical care medicine
Issue number8
StatePublished - Oct 15 2017


  • Geographical heterogeneity in tuberculosis
  • Mathematical modeling of tuberculosis
  • Tuberculosis
  • Tuberculosis in the United States

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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