Minnesota: Highest Rate of Refugee TB Per Capita, then Nebraska and North Dakota

Minnesota has the highest rate of refugee tuberculosis (TB) per capita of any state in the country by a wide margin, with 4.08 cases of active TB diagnosed among refugees for every 100,000 residents in the general population between 2012 and 2015.

Minnesota is followed by Nebraska in the refugee TB per capita rate, where it is 1.26 per 100,000 residents; and North Dakota, where the rate is 1.19 per 100,000 residents.

This data comes from the same four Centers for Disease Control (CDC) annual publications titled Reported Tuberculosis in the United States which Breitbart News reported earlier this month, confirming that 1,565 refugees were diagnosed with TB between 2012 and 2015, more than three times what had been previously reported.

In many states, including Minnesota, the high refugee TB per capita rate explains why refugees who constitute less than one percent of the population accounted for significantly more than 20 times that percentage of all cases of TB diagnosed during the 2012 to 2015 period.

In Minnesota, 36 percent, or 225 out of 610 total cases of TB, were diagnosed in refugees, 55 times greater than the 0.7  percent of the state’s estimated population of refugees, by one measure.

In Kansas, 16 percent, or 25 out of 154 total cases of TB, were diagnosed in refugees, 112 times greater than the 0.14 percent of the state’s estimated population of refugees.

States with high refugee TB per capita rates and high percentages of total TB attributable to refugees also accept a significant number of refugees from high TB burden countries.

Minnesota, for instance, resettles a significant number of Somalis. Indiana resettles many Burmese. More than half of the 4,368 refugees resettled in New Hampshire since FY 2008 are from Bhutan, according to the State Department. Somalia, Burma, and Bhutan are all high TB burden countries.

Nationally, 4.5 percent of all TB cases diagnosed in the 46 states that reported this data were diagnosed in refugees. This percentage is 19 times greater than the percentage of the population that arrived as refugees between 2003 and 2015 (0.235 percent).

The 36,862 refugees that arrived in Minnesota during the 13 years between 2003 and 2015 accounted for less than one percent (0.7 percent) of the state’s population of the state’s 5.5 million population. The total refugee population in Minnesota, or any state, is probably greater than this 13 year refugee arrival number, due to refugees who arrived prior to 2003, as well as secondary migration from one state to another.

Rounding out the top ten states for active TB-diagnosed refugees per 100,000 residents are Iowa (1.02), Idaho (0.95), Georgia (0.94), New Hampshire (0.9), Indiana (0.87), Utah (0.87), and tied for tenth are Kansas (0.86), and Kentucky (0.86). Indiana, Wisconsin, Colorado, Ohio, and Maryland filled out the 11th to 15 positions, as shown in the table below, Refugee TB Per Capita, Top 15 States, 2012 to 2015.

	Refugee TB Per Capita, Top 15 States, 2012 to 2015
	State	RTB per capita*	% TB Refugees	% Pop. Refugees**
1	Minnesota	4.08	36.9%	0.7%
2	Nebraska	1.26	21.4%	0.5%
3	North Dakota	1.19	14.5%	0.6%
4	Iowa	1.02	17.4%	0.2%
5	Idaho	0.95	34.0%	0.6%
6	Georgia	0.94	7.1%	0.3%
7	New Hampshire	0.90	25.0%	0.4%
8	Utah	0.87	19.6%	0.4%
9	Kansas	0.86	16.2%	0.1%
10	Kentucky	0.86	13.3%	0.4%
11	Indiana	0.80	13.8%	0.2%
12	Wisconsin	0.74	19.1%	0.2%
13	Colorado	0.70	14.2%	0.3%
14	Ohio	0.70	5.9%	0.2%
15	Maryland	0.70	5.4%	0.2%
	Total US	0.49	4.1%	0.2%
	Less NR***	0.57	4.5%	0.2%
	Sources:
	Reported Tuberculosis in the United States, 2012, 2013, 2014, 2015
	Department of State interactive website at www.wrapsnet.org
	2016 population estimates from the US Census Bureau * Total refugee TB for four years from 2012 to 2015 per 100,000 residents   (These per capita rates are usually presented on an annual basis)   ** Refugee Arrivals 2003 to 2015 divided by population   *** Non reporting states Arizona, Illinois, Virginia, Washington, not included

Four states and two cities did not provide the CDC with category breakdown for foreign-born residents who were diagnosed with TB by immigration status at arrival: Virginia, Washington, Illinois, Arizona, Washington, D.C., and New York City.

“State, county, and local public health agencies have the primary responsibility for preventing and controlling tuberculosis (TB) in their jurisdiction, and serve as the public health authority for TB, including the responsibility and authority for conducting TB surveillance,” a spokesperson for the CDC told Breitbart News.

“These TB control programs voluntarily share TB surveillance data with CDC through the National TB Surveillance System. Because state and local reporting capacity and privacy laws vary, the depth of data reported in CDC’s national report also varies,” the spokesperson added.

“CDC encourages states/jurisdictions to provide as complete information as possible, but there is no requirement that they provide immigration status as part of routine surveillance,” the spokesperson concluded.

The Virginia Department of Health and the Arizona Department of Health Services told Breitbart News they do not track immigration status upon first arrival of foreign-born residents who contract TB.  As Breitbart News reported previously, slightly more than six percent of the foreign-born cases of TB diagnosed were categorized with refugee immigration status upon first arrival.

The Illinois Department of Public Health (IDPH) told Breitbart News that it does track refugees with TB, but did not report that information to the Centers for Disease Control.

IDPH told Breitbart News that four cases of TB have been diagnosed in refugees resettled in the state of Illinois, but did not specify in which year or years those diagnoses occurred.

The Washington State Department of Health told Breitbart News that 11 cases of TB were diagnosed in refugees in 2015, but has not yet provided that data for 2012, 2013, or 2014.

Breitbart News contacted public health authorities in New York City and Washington, D.C. to learn if they track refugee TB data and does not provide that information to the CDC, but has not yet received a response from either city.

One state, Tennessee, did not provide foreign-born TB data by immigration status upon first arrival in 2012 and 2013, but has subsequently provided that data in 2014 and 2015.

Supporting tables are included below.

Refugees as Percentage of Population
Top 15 Refugee TB Per Capita States, 2012 to 2015
		Refugee Arrrivals
State	% Pop. Refugees	2003 to 2015*	Population
Minnesota	0.7%	36,862	5,519,952
Nebraska	0.5%	8,913	1,907,116
North Dakota	0.6%	4,852	757,952
Iowa	0.2%	6,689	3,134,693
Idaho	0.6%	10,339	1,683,140
Georgia	0.3%	30,797	10,310,371
New Hampshire	0.4%	5,347	1,334,795
Utah	0.4%	12,103	3,051,217
Kansas	0.1%	4,183	2,907,289
Kentucky	0.4%	16,895	4,436,974
Indiana	0.2%	14,658	6,633,053
Wisconsin	0.2%	11,542	5,778,708
Colorado	0.3%	17,523	5,540,545
Ohio	0.2%	25,203	11,614,373
Maryland	0.2%	13,372	6,016,447
Total US	0.2%	766,625	321,418,820
Less NR**	0.2%	656,005	276,763,769
Sources:
Reported Tuberculosis in the United States, 2012, 2013, 2014, 2015
Department of State interactive website at www.wrapsnet.org
2016 population estimates from the US Census Bureau
*January 21, 2003 to December 31, 2015 ** Non reporting states Arizona, Illinois, Virginia, Washington, not included

Total TB Cases and Refuge TB Cases
Top 15 Refugee TB Per Capita States, 2012 to 2015
State	Total	Refugees	Refugee %
Minnesota	610	225	36.9%
Nebraska	112	24	21.4%
North Dakota	62	9	14.5%
Iowa	184	32	17.4%
Idaho	47	16	34.0%
Georgia	1,355	96	7.1%
New Hampshire	48	12	25.0%
Utah	138	27	19.6%
Kansas	154	25	16.2%
Kentucky	286	38	13.3%
Indiana	420	58	13.8%
Wisconsin	225	43	19.1%
Colorado	275	39	14.2%
Ohio	596	35	5.9%
Maryland	773	42	5.4%
Total US	38,429	1,565	4.1%
Less NR*	34,545	1,565	4.5%
Sources:
Reported Tuberculosis in the United States, 2012, 2013, 2014, 2015
Department of State interactive website at www.wrapsnet.org
2016 population estimates from the US Census Bureau
* Non reporting states Arizona, Illinois, Virginia, Washington, not included

Total TB and Refugee TB per 100,000 general population
Refugee TB Per Capita, Top 15 States, 2012 to 2015
	RTB per capita	RTB per capita	Total TB per capita
State	4 year total	Annualized ave.	4 year ave.
Minnesota	4.08	1.02	2.80
Nebraska	1.26	0.32	1.50
North Dakota	1.19	0.30	2.15
Iowa	1.02	0.26	1.48
Idaho	0.95	0.24	0.75
Georgia	0.94	0.24	3.38
New Hampshire	0.90	0.23	0.90
Utah	0.87	0.22	1.18
Kansas	0.86	0.22	1.33
Kentucky	0.86	0.22	1.60
Indiana	0.80	0.20	1.60
Wisconsin	0.74	0.19	1.03
Colorado	0.70	0.18	1.28
Ohio	0.70	0.18	1.28
Maryland	0.70	0.18	3.25
Total US	0.49	0.12	3.03
Sources:
Reported Tuberculosis in the United States, 2012, 2013, 2014, 2015
Department of State interactive website at www.wrapsnet.org
2016 population estimates from the US Census Bureau