Slowdown in the Decline of Tuberculosis Rates in California, 2000-2016.

OBJECTIVES: To determine the impact of the 2007-2009 economic crisis on tuberculosis (TB) trends among California residents.

METHODS: We analyzed available data from 4 different population-representative data sets. We used time charts, trend lines, and change-point detection tests during 2000 to 2016 to describe TB trends in California.

RESULTS: We found statistically significant changes in California TB trends with the time of the onset of the economic downturn based on age-adjusted TB case rates and TB mortality rates, crude rate of TB hospitalizations, and self-reported TB. Change on TB incidence was especially apparent among racial/ethnic minority groups.

CONCLUSIONS: To our knowledge, changes in TB trends in the United States matching in time with the 2007-2009 economic crisis have not been previously reported. This study identified a slowdown in the decline of TB rates by 2007 to 2009 and provides new knowledge on TB trends that can be used to achieve California's goal of eliminating TB by 2040 and in the prevention and control of TB in the United States. (Am J Public Health. Published online ahead of print December 20, 2018: e1-e7. doi:10.2105/AJPH.2018.304816).