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Purpose of Review: Socioeconomic status (SES) has long been understood to be a key determinant of the distribution of tuberculosis (TB), and the role of social factors has long been a truism of TB epidemiology. We review studies that have examined the social determinants of TB in the USA in the past 20 years. We pay particular attention to how the findings of these studies fit within the framework of fundamental cause theory and argue that a more explicit linkage with fundamental cause theory is critical for understanding the current state of TB health disparities in the USA and for charting a way towards TB elimination in the USA., Recent Findings and Summary: Our review finds that while in the past 20 years there have been studies that have documented the ongoing association between social factors and TB disease in the USA, few studies explore the precise mechanisms through which social factors continue to influence TB patterns. We advocate for a move towards a system-based approach both in theory development and analyses, allowing for the incorporation of more complex social dynamics to address long-standing disparities in TB disease., Competing Interests: Conflict of Interest Grace A. Noppert reports grants from Eunice Kennedy Shriver National Institute of Child Health and Human Development during the conduct of the study. Ryan E. Malosh reports grants from Multiparty Group for Advice on Science, outside the submitted work. Elizabeth B. Moran, Shama D. Ahuja, and Jon Zelner each declare no potential conflicts of interest.