Tuberculosis mortality associated with AIDS and drug or alcohol abuse: analysis of multiple cause-of-death data.

The resurgence in tuberculosis morbidity in the mid-1980s has increased interest in tuberculosis mortality. We examined mortality in the United States, from tuberculosis in 1990, using multiple cause-of-death data to describe the impact of AIDS and substance abuse, defined as drug or alcohol abuse, on mortality from tuberculosis. Tuberculosis mortality by age showed a bimodal pattern, with a peak between ages 25 and 55; by race/ethnicity, black and Hispanic males had the highest mortality rates, and black females had rates close to those of Hispanic males. Although in each of the race/ethnicity categories the removal of deaths with AIDS resulted in mortality curves closer to those of 1980, the bimodal pattern remained for black and Hispanic deaths. When we examined deaths with tuberculosis and substance abuse, we found that substance abuse without AIDS may account for additional deaths contributing to the bimodal pattern seen.