Southwest Alaska carried most of the state's tuberculosis cases last year

Southwest Alaska, home to about 5 percent of the state's population, accounted for 46 of Alaska's 77 tuberculosis cases last year — nearly six in ten, according to the state's annual infectious disease report.

The gap between regions is wide. The Southwest region's rate works out to roughly 113 cases per 100,000 people, against 5.9 in Anchorage — about nineteen times higher — and about 10 statewide. Anchorage, with more than seven times the Southwest's population, reported 17 cases. The Interior and Northern regions reported five each, Southeast three, Mat-Su one, and the Gulf Coast none.

The region takes in the Bethel and Kusilvak census areas, the Dillingham Census Area, the Aleutians, and the Bristol Bay and Lake and Peninsula boroughs — largely Alaska Native communities, which the state has acknowledged bear the heaviest share of the disease. Southwest and Northern Alaska "consistently have the highest rates of TB in the state, and the Alaska Native population bears a disproportionate burden of cases," the epidemiology section wrote in an earlier summary.

The state has attributed those rates to a long history: "the lingering effects of a devastating TB epidemic in the 19th and 20th centuries, coupled with ongoing challenges with TB control in many rural Alaska communities."

Statewide, the numbers have been moving. Active cases jumped 66 percent in 2022, and Alaska's 2024 rate — 91 cases, 12.3 per 100,000 — was the highest of any state. Provisional figures show cases falling to 77 last year. The scale of the gap shows up in research, too: one 2024 study found that between 2010 and 2020, tuberculosis among Alaska Native people ran 21 times the rate among American Indian and Alaska Native people in other states.

Most people infected with TB never develop active disease; the state puts the lifetime risk at 5 to 10 percent. The counts in the new report are provisional and may change.