From decline to rebound: a 25-year Joinpoint analysis of tuberculosis mortality in the United States, 1999–2023

Following decades of consistent decline, tuberculosis (TB) mortality in the United States has exhibited indicators of stagnation since 2014. National-level summaries, however, conceal variability within demographic and geographic subgroups. Our objective was to quantify current trends and identify the demographics responsible for the deceleration. Utilizing the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) mortality data (1999–2023), we computed age-adjusted mortality rates (AAMR) for all fatalities with underlying ICD-10 codes A16–A19. Joinpoint regression was utilized to calculate annual percent changes (APC) and average annual percent changes (AAPC) overall and stratified by sex, age, race/ethnicity, census area, and urbanization. Tuberculosis-related fatalities decreased from 911 in 1999 to 566 in 2023, resulting in an overall annual average percentage reduction of −3.36% (95% CI −4.55% to −2.15%). In 2014, the national trend flipped; the APC transitioned from −5.86% (1999–2014) to +1.64% (2014–2023). Males encountered a more pronounced deceleration (APC −0.75% post-2011) compared to females. Adults aged 45–54 years experienced a fall of 5.01% per annum until 2017, followed by an increase of 3.71% per annum until 2023. Comparable reversals transpired in the 65–74 age cohorts, while individuals aged 85 and above had a consistent linear fall (APC −3.91%). The South and Northeast demonstrated the most pronounced reversals post-2015, with annual percentage changes of +1.98% and +3.03%, respectively. Metropolitan counties had a resurgence post-2015, with an increase of 2.69%, while non-metropolitan regions stabilized. Non-Hispanic Black adults experienced the most significant early drop (APC −9.12%, 1999–2013) and Non-Hispanic Asian adults continued to represent the largest burden group in 2023. U.S. tuberculosis mortality has shifted from a rapid drop to stagnation or resurgence, particularly evident among middle-aged and older adults, males, urban inhabitants, and those in Southern and Northeastern states. Urgent, equity-centered actions are essential to avert further recurrence and expedite elimination.