Tuberculosis Case Trends in Georgia Before and During the COVID-19 Pandemic, 2015–2022 Open Access
Denget, Blain (Spring 2026)
Abstract
Using population-level aggregate data, the study investigated whether patterns of diagnosed tuberculosis (TB) in Georgia have changed during the COVID-19 pandemic in terms of stability of over time trends and across various subgroups. The Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) system provided annual data on reported cases of adult TB (defined as all cases occurring in individuals aged 25 years or greater) for the years 2015–2022. Using an interrupted time series design in which 2020–2022 were considered to be in the COVID-19 period, we fit a series of negative binomial regression models that adjusted for the population offset and were used to describe changes in overtime trends that are relevant to the investigated case patterns of diagnosed TB.
Before COVID-19, TB incidence showed a slow and non-significant decline. In 2020, the year in which COVID-19 was confirmed worldwide, there was a statistically significant decline in TB incidence. Since then, incidence has risen again in a statistically significant manner during the pandemic period. Most likely, the fall in incidence due to COVID-19 was due to the interruptions in health services caused by the pandemic and the subsequent fall in the reporting of TB cases, rather than a real decrease in the incidence of the disease.
The sex and race/ethnicity patterns of TB disease did not change substantially over time. Male, non-Hispanic Black, and Hispanic/Latino populations continued to have more concentrated TB case burdens before and during the COVID-19 pandemic. Overall, the relative distribution of TB burden among these populations did not change much, despite the changes in TB case trends over time.
The COVID-19 pandemic is suspected to have disrupted TB surveillance and care activities in Georgia, resulting in a steep decline in reported cases, followed by a recovery trend. Disparities in TB burden for vulnerable populations have also persisted. These findings highlight the importance of uninterrupted TB detection and treatment services during large public health events such as COVID-19 pandemics and populations with a greater burden of disease.
Table of Contents
Table of Contents
Abstract 2
Introduction 6
Background 7
Tuberculosis Disparities and Social Determinants of Health 7
COVID-19 Pandemic and Impact on Public Health 8
Impact of COVID-19 on Tuberculosis Detection and Reporting 9
Behavioral and Structural Changes During the Pandemic 10
Gaps in the Literature and Study Rationale 11
Methods 11
Data 11
Study Measures 12
Statistical Analysis 12
Results 14
Characteristics of the Study Sample 14
Aim 1) Case Trends in Georgia from 2015 – 2022 and Changes in Incidence Pre-Pandemic and During the Pandemic 15
Aim 2) Immediate and longer-term effects of the pandemic on TB case patterns in Georgia from 2015 to 2022 15
Aim 3) Changes in incidence associated with the COVID-19 across demographic groups 16
Discussion 17
Tables and Figures 19
Figure 1. TB Incidence Rate per 100,000 in Georgia, 2015 - 2022 21
References 23
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