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Show Tuberculosis (Cases in 1994 in Utah = 55) Tuberculosis (TB) continues to be a major public health problem, both nationally and internationally. Each year there are an estimated 8 to 10 million new cases, with 3 million deaths reported worldwide.1 In Utah, the Utah Department of Health Bureau of Epidemiology reports that TB has re-emerged as a public health problem in Utah after a 30-year period of decline. Utah's incidence rate for tuberuculosis has consistently been lower than the national rate. The Utah:U.S. ratio shows Utah rates to be approximately 30% of the national rates. Through 1985, tuberculosis rates in Utah and the United States were declining. However, since that time, TB incidence has been generally increasing. Tuberculosis is an infectious disease, but it has many social aspects as well. Poverty, overcrowding, and malnutrition may all contribute to contracting this disease. The homeless population is therefore at a higher risk for tuberculosis. In Utah from 1991 to 1993, the homeless population comprised 25% of reported cases.2 This is alarming for many reasons. First, the homeless population represents only 1% of the state's total population but 25% of the reported cases. Second, there may be a much higher incidence due to the under-reporting of disease in the homeless. Furthermore, it is particularly difficult to track and treat TB in the homeless population because many do not have regular contact with a health care delivery system. 1 Kent J.T. 1993 Medical Clinics of North America Epidemiology of Multidrug-resistant Tuberculosis in the U.S. Vol. 77 No. 6, November 1993. 2 Utah Department of Health, Bureau of Epidemiology. Unpublished report. Currently, efforts are being made by the staff of the community homeless shelters to screen the residents for tuberculosis. As screening increases, an even higher incidence of tuberculosis would be expected. Other populations may be at a greater risk for tuberculosis as well. These include low-income groups, residents of long-term care facilities, the elderly, and AIDS patients. Active tuberculosis is more likely with a compromised immune system, making people with AIDS more vulnerable to disease. The data below are based on reported cases. This may not represent total incidence in the community. Better ways of assessing at risk populations are needed. Table 59. Tuberculosis* Utah:U.S. Year Utah U.S. (Ratio) 1970 1.2 18.2 0.07:1 1981 4.2 11.9 0.35:1 1982 3.3 11 0.30:1 1983 2.9 10.2 0.28:1 1984 2.5 9.4 0.27:1 1985 1.9 9.3 0.20:1 1986 2.6 9.4 0.28:1 1987 1.7 9.3 0.18:1 1988 2.1 9.1 0.23:1 1989 3.3 9.5 0.35:1 1990 3.0 10.3 0.29:1 1991 2.6 10.4 0.25:1 1992 4.3 10.5 0.41:1 1993 2.5 9.8 0.26:1 1994 2.9 - - ?Incidence rates per 100,000 population. Figure 33 Utah's Health: An Annual Review 1995 81 |