California data demonstrate failures in latent tuberculosis screening to prevent progression of tuberculosis disease. Authors developed a clinical risk prediction model for tuberculosis disease using electronic health records. This study included Kaiser Permanente Southern California and Northern California members ≥18 years during 2008–2019. 

Findings: Of 4,032,619 and 4,051,873 Southern and Northern California members, tuberculosis disease incidences were 4.1 and 3.3 cases per 100,000 person-years, respectively. The final model C-statistic was 0.816. Model sensitivity screening high-risk individuals was 0.70 and number-needed-to-screen was 662 persons-per tuberculosis disease case, compared to a sensitivity of 0.36 and number-needed-to-screen of 1632 with current screening. Authors conclude their predictive model improves tuberculosis screening efficiency in California.