Background: Although tuberculosis (TB) morbidity and mortality have decreased in recent decades, challenges exist regarding disproportionate distributions of TB among specific populations and geographic areas. Inconsistent local health department (LHD) funding for TB programs poses difficulties for LHDs to sustain resources and personnel that predisposes communities to risks of future outbreaks of TB and drug-resistant TB diseases.

Purpose: This study examined relationships between annual TB incidence rates and LHD expenditures on TB-related services to elucidate potential impacts of TB incidence on LHD TB spending.

Methods: This dataset included county-level TB incidence data with comparable, annual (2000–2010) TB-related service expenditures for each of the 160 LHDs in Florida, New York, and Washington States. A panel study design was adopted to estimate relationships between county-specific TB incidence and LHD TB service expenditures, while accounting for demographic, geographic, and TB service provision factors.

Results: Following declines in TB incidence, funding for LHD TB programs in Florida, New York, and Washington State has similarly declined. This study demonstrated significant, positive association between TB incidence rate and per capita TB expenditures. Jurisdictions with higher percentages of foreign-born and black populations had significantly higher TB service spending. Micropolitan jurisdictions had significantly lower TB service spending than metropolitan jurisdictions.

Implications: Effective TB control and prevention requires sustainable resources and strategies to assure local public health capacity for timely and thorough responsiveness to TB outbreaks. This capacity may need to be in the forms of cross jurisdiction sharing, state-level support, and partnerships with alternative providers in communities.