Trends in death with tuberculosis during the AIDS era

Deaths associated with tuberculosis have paralleled the rise of the AIDS epidemic. Data from the National Center for Health Statistics were analyzed for deaths with tuberculosis between 1980 and 1990 and/or deaths with AIDS between 1987 and 1990. In 1980, which was near the beginning of the AIDS epidemic, deaths with tuberculosis peaked among those aged 70 to 74. By 1985, there had been a decline in deaths with tuberculosis among those aged 50 to 79 and a slight increase among those aged 20 to 44. By 1990, there had been a significant increase in the deaths with tuberculosis among those aged 20 to 44, so that deaths with tuberculosis peaked among those aged 20 to 44 and those aged 70 to 74. In 1990, the proportions of tuberculosis deaths with AIDS among those aged 20 to 49 were 59% of whites, 49.5% of blacks and 65.1% of Hispanics. Death with tuberculosis among those aged 20 to 49 increased 362% between 1982 and 1990 in the five states with the highest rates of AIDS.
Objective.--To describe and analyze recent changes in tuberculosis mortality in the United States during the acquired immunodeficiency syndrome (AIDS) epidemic. Design.--We used National Center for Health Statistics multiple-cause mortality data and analyzed deaths with tuberculosis (1980 through 1990) and/or AIDS (1987 through 1990) as an underlying or associated cause. We also categorized the 50 states and the District of Columbia into high (five states), medium (23 states), and low (23 states) AIDS incidence groups and then compared the groups' rates of death with tuberculosis during the period 1980 through 1990. Study Population.--Residents of the United States who died in the period 1980 through 1990. Main Outcome Measures.--Death certificates indicating AIDS and/or tuberculosis. Results.--A bimodal age distribution of persons dying with tuberculosis has emerged concurrent with the AIDS epidemic. A new peak spanning the ages 20 to 49 years accompanies the preexisting peak in the elderly. In 1990, 54.2% (729/1344) of the deaths with tuberculosis in persons 20 to 49 years of age occurred in persons who also had AIDS listed on their death certificates. During the period 1987 through 1990, there was an increasing trend in the proportion of AIDS deaths that also had tuberculosis: 2.3% (353/15 075)in 1987, 2.5% (460/18 649)in 1988, 3.0% (738/24 607)in 1989, and 3.0% (836/27 975)in 1990 (P Conclusion.--The AIDS epidemic has significantly increased the number and rate of tuberculosis deaths in younger adults through 1990, although in this study discrimination of deaths due to tuberculosis from deaths with tuberculosis was not possible. Vigorous efforts to prevent and treat tuberculosis and AIDS are indicated to reverse the trends we have described. (JAMA. 1993;269:2865-2868)