For nearly three decades, tuberculosis followed a reassuring trajectory in the United States: case counts declining year after year, the disease receding from public consciousness, treated as a solved problem of the developing world rather than an active threat in American cities. That trajectory reversed in 2021. And by 2024, the CDC reported over 10,347 TB cases nationally — an 8% increase in case counts and a 6% increase in rates from 2023 — with four states accounting for a disproportionate share of the burden: California, Florida, New York, and Texas. Dallas County consistently ranks among the highest-burden areas in Texas, which itself recorded 1,243 TB cases in 2023 alone. For Dallas residents, tuberculosis is no longer a distant historical concern — it is an active, circulating disease in the city's most densely populated and vulnerable communities.
Dallas County's TB burden is not accidental. It reflects the county's demographic composition, its density of congregate living settings, its large foreign-born population, and the specific risk factors that the Texas Department of State Health Services has identified as driving transmission: 67.9% of Texas TB cases occur in foreign-born individuals, and among U.S.-born cases, diabetes (24.2%), heavy alcohol use (11.8%), correctional facility residence (11.2%), and non-injection drug use (9.4%) are the most common risk factors. Dallas — with its large immigrant population, its county jail that regularly houses thousands of individuals, and its significant population of residents with diabetes and substance use disorders — ticks virtually every box.
