Navigating toward TB elimination: the California perspective

Background The California tuberculosis (TB) elimination plan calls for testing more than ten million at-risk Californians and treating two million infected with tuberculosis. Detailed knowledge about the at-risk population and the healthcare providers who serve them is crucial to further reduction of the TB burden in the state. Methods We used data from the population-based 2014-2017 California Health Interview Survey (CHIS) to examine demography, healthcare access and utilization, and language use, focusing on countries of birth with the highest number of TB cases in California. Results The six top countries of birth accounting for 62% of TB cases were Mexico, United States (U.S.), Philippines, Vietnam, China and India. CHIS data showed that poverty was highest among Mexican-born persons, 56% (CI: 54-58) and lowest among Indian-born persons, 9% (CI: 5-13). Report of recent doctor’s visit was highest among persons born in the Philippines, 84% (CI: 80-89) and lowest among Chinese-born persons, 70% (CI: 63-76). Persons born in Mexico were more likely to report community clinics as their usual source of care than persons born in China, Vietnam or the Philippines. Among 18-64 year olds, 27% (CI: 25-30) of persons born in Mexico reported being uninsured in contrast with 3% (CI: 1-5) of persons born in India. Of adults with a medical visit in a non-English language, 96% (CI: 96-97) were non-U.S.-born, but only 42% (CI: 40-44) of non-U.S.-born persons had a visit in a non-English language. Discussion Patterns of demography, healthcare utilization and language use were notably different by country of birth. These differences should be considered when planning outreach to specific providers, clinic systems, insurers and communities for TB prevention and case-finding.