In 1999, those who had reported they were unemployed within the preceding 24 months accounted for nearly 60 percent of all cases of the disease (CDC, 2000b). Those who reported their occupation as health care workers within the preceding 24 months accounted for approximately 2.6 percent of the cases nationwide, down from 3.0 percent in 1998. In 1998, health care workers accounted for about 9 percent of employed persons and 8 percent of tuberculosis cases among employed persons (Amy Curtis, CDC, 2000, personal communication).5 During the period from 1994 to 1998, six states—California, Florida, Illinois, New Jersey, New York, and Texas—accounted for 57 percent of the cases of tuberculosis among health care workers and about the same percentage of all tuberculosis cases. (The six states account for just under 40 percent of the U.S. population.)
As shown in Figure 5-1, for the period 1994 to 1998, the overall incidence of active tuberculosis among health care workers was similar to that for other employed workers—about 5.1 per 100,000 population for the former and 5.0 per 100,000 population for the latter (Curtis et al., 1999). Between 1994 and 1998, the tuberculosis case rate for health care workers dropped from 5.6 to 4.6 per 100,000 population, whereas the rates for other employed workers stayed relatively steady at 5.2 per 100,000 population in both 1994 and 1998.
Looking only at cases of drug-resistant tuberculosis among U.S.-born workers from 1994 to 1998, CDC analysts found significantly higher rates of drug-resistant disease for health care workers (3.2 percent of cases) than for other workers (1.5 percent of cases) (Panlilio and Curtis, 2000). For the 2 most recent years, the difference in rates for the two groups was not statistically significant.
Among foreign-born health care workers, those born in the Philippines account for the largest percentage of cases of active tuberculosis (about 33 percent) (Curtis et al., 1999). Among all foreign-born employed workers (and for the U.S. population generally), those born in Mexico accounted for the highest percentage (about 25 percent) of tuberculosis cases.
In 1999, CDC reported that workers in correctional facilities accounted for about 0.1 percent of cases of active tuberculosis (CDC, 2000b). Most information on correctional facilities focuses on inmates, who have much
Health care and correctional workers account for about 95 percent of those covered by the proposed rule. The CDC data are based on reported occupation within the past 24 months (CDC, 2000b). Most of the progression from infection to active tuberculosis occurs within the first two years following infection. CDC first began collecting occupational data in 1993, but the initial reports are considered less reliable than subsequent ones. In recent years, approximately 500 to 600 cases of tuberculosis among health care workers have been reported yearly.