Peter J Dodd1, Courtney M Yuen2, Shamanthi M Jayasooriya3, Marieke M van der Zalm4, James A Seddon5. 1. School of Health and Related Research, University of Sheffield, Sheffield, UK. Electronic address: p.j.dodd@sheffield.ac.uk. 2. Harvard Medical School, Harvard University, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. 3. Academic Unit of Primary Care, University of Sheffield, Sheffield, UK. 4. Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa. 5. Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London, London, UK.
Abstract
BACKGROUND: People who survive tuberculosis face clinical and societal consequences after recovery, including increased risks of recurrent tuberculosis, premature death, reduced lung function, and ongoing stigma. To describe the size of this issue, we aimed to estimate the number of individuals who developed first-episode tuberculosis between 1980 and 2019, the number who survived to 2020, and the number who have been treated within the past 5 years or 2 years. METHODS: In this modelling study, we estimated the number of people who survived treated tuberculosis using country-level WHO data on tuberculosis case notifications, excluding those who died during treatment. We estimated the number of individuals surviving untreated tuberculosis using the difference between WHO country-level incidence estimates and notifications, applying published age-stratified and HIV-stratified case fatality ratios. To estimate survival with time, post-tuberculosis life tables were developed for each country-year by use of UN World Population Prospects 2019 mortality rates and published post-tuberculosis mortality hazard ratios. FINDINGS: Between 1980 and 2019, we estimate that 363 million people (95% uncertainty interval [UI] 287 million-438 million) developed tuberculosis, of whom 172 million (169 million-174 million) were treated. Individuals who developed tuberculosis between 1980 and 2019 had lived 3480 million life-years (95% UI 3040 million-3920 million) after tuberculosis by 2020, with survivors younger than 15 years at the time of tuberculosis development contributing 12% (95% UI 7-17) of these life-years. We estimate that 155 million tuberculosis survivors (95% UI 138 million-171 million) were alive in 2020, the largest proportion (47% [37-57]) of whom were in the WHO South-East Asia region. Of the tuberculosis survivors who were alive in 2020, we estimate that 18% (95% UI 16-20) were treated in the past 5 years and 8% (7-9) were treated in the past 2 years. INTERPRETATION: The number of tuberculosis survivors alive in 2020 is more than ten times the estimated annual tuberculosis incidence. Interventions to alleviate respiratory morbidity, screen for and prevent recurrent tuberculosis, and reduce stigma should be immediately prioritised for recently treated tuberculosis survivors. FUNDING: UK Medical Research Council, the UK Department for International Development, the National Institute for Health Research, and the European and Developing Countries Clinical Trials Partnership.
BACKGROUND:People who survive tuberculosis face clinical and societal consequences after recovery, including increased risks of recurrent tuberculosis, premature death, reduced lung function, and ongoing stigma. To describe the size of this issue, we aimed to estimate the number of individuals who developed first-episode tuberculosis between 1980 and 2019, the number who survived to 2020, and the number who have been treated within the past 5 years or 2 years. METHODS: In this modelling study, we estimated the number of people who survived treated tuberculosis using country-level WHO data on tuberculosis case notifications, excluding those who died during treatment. We estimated the number of individuals surviving untreated tuberculosis using the difference between WHO country-level incidence estimates and notifications, applying published age-stratified and HIV-stratified case fatality ratios. To estimate survival with time, post-tuberculosis life tables were developed for each country-year by use of UN World Population Prospects 2019 mortality rates and published post-tuberculosismortality hazard ratios. FINDINGS: Between 1980 and 2019, we estimate that 363 million people (95% uncertainty interval [UI] 287 million-438 million) developed tuberculosis, of whom 172 million (169 million-174 million) were treated. Individuals who developed tuberculosis between 1980 and 2019 had lived 3480 million life-years (95% UI 3040 million-3920 million) after tuberculosis by 2020, with survivors younger than 15 years at the time of tuberculosis development contributing 12% (95% UI 7-17) of these life-years. We estimate that 155 million tuberculosis survivors (95% UI 138 million-171 million) were alive in 2020, the largest proportion (47% [37-57]) of whom were in the WHO South-East Asia region. Of the tuberculosis survivors who were alive in 2020, we estimate that 18% (95% UI 16-20) were treated in the past 5 years and 8% (7-9) were treated in the past 2 years. INTERPRETATION: The number of tuberculosis survivors alive in 2020 is more than ten times the estimated annual tuberculosis incidence. Interventions to alleviate respiratory morbidity, screen for and prevent recurrent tuberculosis, and reduce stigma should be immediately prioritised for recently treated tuberculosis survivors. FUNDING: UK Medical Research Council, the UK Department for International Development, the National Institute for Health Research, and the European and Developing Countries Clinical Trials Partnership.
Authors: G B Migliori; F M Marx; N Ambrosino; E Zampogna; H S Schaaf; M M van der Zalm; B Allwood; A L Byrne; K Mortimer; R S Wallis; G J Fox; C C Leung; J M Chakaya; B Seaworth; A Rachow; B J Marais; J Furin; O W Akkerman; F Al Yaquobi; A F S Amaral; S Borisov; J A Caminero; A C C Carvalho; D Chesov; L R Codecasa; R C Teixeira; M P Dalcolmo; S Datta; A-T Dinh-Xuan; R Duarte; C A Evans; J-M García-García; G Günther; G Hoddinott; S Huddart; O Ivanova; R Laniado-Laborín; S Manga; K Manika; A Mariandyshev; F C Q Mello; S G Mpagama; M Muñoz-Torrico; P Nahid; C W M Ong; D J Palmero; A Piubello; E Pontali; D R Silva; R Singla; A Spanevello; S Tiberi; Z F Udwadia; M Vitacca; R Centis; L D Ambrosio; G Sotgiu; C Lange; D Visca Journal: Int J Tuberc Lung Dis Date: 2021-10-01 Impact factor: 3.427
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