Data & Statistics
Here are some basic definitions that may be helpful in understanding the slides and statistics on this page:
Latent TB Infection (LTBI)
- Infected with TB bacteria but does not feel ill
- Has positive tuberculin skin test (TST): generally has induration of 10 mm or greater
- Usually has normal chest x-ray
- Not infectious
- Not reported to Department of Health (DOH)
Active TB Disease or TB Case
- Infected with TB bacteria and generally feels sick (usually: cough, fever, weight loss)
- Usually has positive tuberculin skin test (TST): generally has induration of 10 mm or greater
- Usually has abnormal chest x-ray (pulmonary cases)
- Potentially infectious
- Reported to Department of Health (DOH)
Case Rate
- A standardized measure used to compare how much disease there is in communities or groups of different sizes
- Usually expressed as: Number of cases/100,000 population
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- Example #1: Hilo, Hawaii (zip code: 96720): (2 cases/42,916 population)*100,000 = Rate of 5 cases/100,000
- Example #2: Kapaa, Kauai (zip code: 96746): (2 cases/16,188 population)*100,000 = Rate of 12 cases/100,000
Current TB Epidemiology in Hawaii (Quick links)
Click here for the complete set of slides for Tuberculosis in Hawaii (2023) in PDF form
Case Rates and Numbers
The State of Hawaii to reports one of the highest annual tuberculosis (TB) case rates in the country. In 2023, Hawaii reported 116 total cases of TB, a rate of 8.1 new cases per 100,000 people and the second highest in the nation that year. Although TB rates have declined over the past decade, Hawaii’s 2023 rate was almost three times higher than the 2023 national TB case rate of 2.9 per 100,000 (Centers for Disease Control and Prevention (CDC), 2024).
TB Case Rates: Hawaii vs. United States, 2004-2023
Reported TB Cases: Hawaii, 1930-2023
Cases by County
Hawaii had an average of 113 reported TB cases over the past 10 years. In 2023, the County of Honolulu reported the highest number of TB cases in the state, with 82 cases of TB and the highest county incidence rate of 8.3 cases per 100,000, accounting for 67% of the state’s TB morbidity in 2023. Kauai County reported 5 new cases of TB with an incidence rate of 6.8 cases per 100,000. Maui County reported 15 new cases of TB (incidence rate: 9.1 cases per 100,000) and Hawaii County reported 14 new cases of TB (incidence rate: 6.7 cases per 100,000).
Reported TB Cases: Hawaii, 2014 -2023
TB Cases and Case Rates by County: Hawaii, 2022-2023
TB Cases and Case Rates by County and Zip Code: Hawaii, 2023
Deaths from TB
TB deaths and death rates have decreased dramatically since 1920 when there were 531 TB-related deaths, and the death rate was 204 per 100,000. In 2023, there were 12 reported deaths attributed to TB in Hawaii, giving a TB mortality rate of 0.8 per 100,000. The latest national data show a TB mortality rate of 0.2 per 100,000, or 602 total TB-related deaths in the US in 2021 (CDC, 2023).
TB Deaths and Death Rates: Hawaii, 1920-2023
TB Deaths and Death Rates: Hawaii, 2014-2023
Cases by Age Group and Gender
The highest burden of TB disease continues to be among older adults. The largest group of new TB cases reported in 2023 in Hawaii were those 65+ years of age; 52% (n=60) were in this age group. There were two new cases of TB under 15 years of age. Additionally, there were 40% more men diagnosed than women (n=81 vs. n=35, respectively). 2022 National data show that the majority of cases were male (61.9%) (CDC, 2023).
Percent of TB Cases by Age Group and Gender: Hawaii, 2023 vs. United States, 2023
Site of Disease
Seventy-five percent (n=87) of cases reported in Hawaii in 2023 were pulmonary TB, or TB affecting the lungs. Tuberculosis, however, is a systemic disease and can affect any area of the body. Ten percent (n=12) of cases were exclusively extrapulmonary, or TB outside of the lungs, while 15% (n=17) were both pulmonary and extrapulmonary. Overall, 90% of cases were either pulmonary or both pulmonary and extrapulmonary. National TB data show that a lower proportion, or 81%, of all cases reported in the US in 2022 were pulmonary or both pulmonary and extrapulmonary (CDC, 2023).
The percentage of TB cases in Hawaii with INH-resistant TB increased from 7% in 2022 to 10% in 2023. In 2022 & 2023, there were no multidrug-resistant TB cases (MDR TB) in Hawaii. MDR TB is defined by CDC as resistance to at least isoniazid (INH) and rifampin (RIF), isolates may be resistant to other drugs. The national INH-resistant TB rate was 8.4 and the national MDR TB rate was 1.4% of all cases in 2022 (CDC, 2023). To prevent development of drug resistant TB, directly observed therapy (DOT) is the standard of care in Hawaii.
TB and HIV
In 2023, 99% of persons with TB in Hawaii reported HIV test results. In 2023, there were no new TB cases in Hawaii that were co-infected with HIV. However, in 2022, 2% of cases reported co-infection with HIV. TB-HIV co-infection remains less common in Hawaii than on the U.S. mainland.
The burden of TB disease in Hawaii is primarily among foreign-born persons from Asia and the U.S.-affiliated Pacific Islands. Persons from these TB endemic countries continue to immigrate and migrate to Hawaii with many immigrants arriving with active TB disease and latent TB infection (LTBI), impacting TB morbidity. Screening of foreign-born clients in state TB clinics in Hawaii in 2023 found that 26.5% had LTBI. If left untreated, these clients may be the TB cases of the future.
In 2023, 110 new TB cases, representing 95% of the state’s morbidity, were foreign-born. Among the foreign-born cases, the majority (61%) were born in the Philippines, followed by persons born in the Federated States of Micronesia (8%), Republic of the Marshall Islands (8%), Vietnam (5%), and China (4%). Note that the CDC counts persons born in the U.S. territories (i.e., Guam, American Samoa and Puerto Rico) as U.S.-born. In 2022, 73.8% of all active TB cases reported in the U.S. were non-US born and this percentage has risen steadily since 1993 (CDC, 2023).
US & Non-US Born Status of All Persons Reported with TB, Hawaii 2023
Countries of Birth for Non-US Born Persons Reported with TB: Hawaii, 2023TB Cases Born in the U.S.-Affiliated Pacific Islands: Hawaii, 2014-2023
Percent of Foreign-born TB Cases by Years of Residence in U.S. Prior to Diagnosis: Hawaii, 2023
Current TB Epidemiology in the U.S.
For the most current national TB data, visit the Centers for Disease Control and Prevention, Division of Tuberculosis Elimination website: https://www.cdc.gov/tb/statistics/default.htm
The Reported Tuberculosis in the United States, 2023 can be accessed at:
Tuberculosis — United States, 2023 (cdc.gov)
This page last updated: November 11, 2024
Hawaii Tuberculosis Control Program
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Honolulu, HI 96817
Phone: (808) 832-5731
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