Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae
Summary: Background: Many individuals who survive tuberculosis disease face ongoing disability and elevated mortality risks. However, the impact of post-tuberculosis sequelae is generally omitted from policy analyses and disease burden estimates. We therefore estimated the global burden of tubercul...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-12-01
|
| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X21003673 |
| _version_ | 1818836613811142656 |
|---|---|
| author | Nicolas A Menzies, PhD Matthew Quaife, PhD Brian W Allwood, PhD Anthony L Byrne, PhD Anna K Coussens, PhD Anthony D Harries, ProfMD Florian M Marx, PhD Jamilah Meghji, PhD Debora Pedrazzoli, PhD Joshua A Salomon, ProfPhD Sedona Sweeney, PhD Sanne C van Kampen, PhD Robert S Wallis, ProfMD Rein M G J Houben, PhD Ted Cohen, ProfDPH |
| author_facet | Nicolas A Menzies, PhD Matthew Quaife, PhD Brian W Allwood, PhD Anthony L Byrne, PhD Anna K Coussens, PhD Anthony D Harries, ProfMD Florian M Marx, PhD Jamilah Meghji, PhD Debora Pedrazzoli, PhD Joshua A Salomon, ProfPhD Sedona Sweeney, PhD Sanne C van Kampen, PhD Robert S Wallis, ProfMD Rein M G J Houben, PhD Ted Cohen, ProfDPH |
| author_sort | Nicolas A Menzies, PhD |
| collection | DOAJ |
| description | Summary: Background: Many individuals who survive tuberculosis disease face ongoing disability and elevated mortality risks. However, the impact of post-tuberculosis sequelae is generally omitted from policy analyses and disease burden estimates. We therefore estimated the global burden of tuberculosis, inclusive of post-tuberculosis morbidity and mortality. Methods: We constructed a hypothetical cohort of individuals developing tuberculosis in 2019, including pulmonary and extrapulmonary disease. We simulated lifetime health outcomes for this cohort, stratified by country, age, sex, HIV status, and treatment status. We used disability-adjusted life-years (DALYs) to summarise fatal and non-fatal health losses attributable to tuberculosis, during the disease episode and afterwards. We estimated post-tuberculosis mortality and morbidity based on the decreased lung function caused by pulmonary tuberculosis disease. Findings: Globally, we estimated 122 (95% uncertainty interval [UI] 98–151) million DALYs due to incident tuberculosis disease in 2019, with 58 (38–83) million DALYs attributed to post-tuberculosis sequelae, representing 47% (95% UI 37–57) of the total burden estimate. The increase in burden from post-tuberculosis varied substantially across countries and regions, driven largely by differences in estimated case fatality for the disease episode. We estimated 12·1 DALYs (95% UI 10·0–14·9) per incident tuberculosis case, of which 6·3 DALYs (5·6–7·0) were from the disease episode and 5·8 DALYs (3·8–8·3) were from post-tuberculosis. Per-case post-tuberculosis burden estimates were greater for younger individuals, and in countries with high incidence rates. The burden of post-tuberculosis was spread over the remaining lifetime of tuberculosis survivors, with almost a third of total DALYs (28%, 95% UI 23–34) accruing 15 or more years after incident tuberculosis. Interpretation: Post-tuberculosis sequelae add substantially to the overall disease burden caused by tuberculosis. This hitherto unquantified burden has been omitted from most previous policy analyses. Future policy analyses and burden estimates should take better account of post-tuberculosis, to avoid the potential misallocation of funding, political attention, and research effort resulting from continued neglect of this issue. Funding: National Institutes of Health. |
| first_indexed | 2024-12-19T03:09:24Z |
| format | Article |
| id | doaj.art-21d914f0666c40ee84545434ff596058 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-19T03:09:24Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-21d914f0666c40ee84545434ff5960582022-12-21T20:38:02ZengElsevierThe Lancet Global Health2214-109X2021-12-01912e1679e1687Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelaeNicolas A Menzies, PhD0Matthew Quaife, PhD1Brian W Allwood, PhD2Anthony L Byrne, PhD3Anna K Coussens, PhD4Anthony D Harries, ProfMD5Florian M Marx, PhD6Jamilah Meghji, PhD7Debora Pedrazzoli, PhD8Joshua A Salomon, ProfPhD9Sedona Sweeney, PhD10Sanne C van Kampen, PhD11Robert S Wallis, ProfMD12Rein M G J Houben, PhD13Ted Cohen, ProfDPH14Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA; Correspondence to: Dr Nicolas A Menzies, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA 02115, USATB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKDivision of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South AfricaHeart Lung Clinic, St Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; Socios En Salud Sucursal Peru, Partners In Health, Lima, PeruInfectious Diseases and Immune Defence Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory WC, South Africa; Department of Medical Biology, University of Melbourne, Parkville, VIC, AustraliaFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; International Union Against Tuberculosis and Lung Disease, Paris, FranceDSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South AfricaDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UKTB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKDepartment of Medicine, Stanford University, Palo Alto CA, USAFaculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UKDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, NetherlandsThe Aurum Institute, Parktown, Johannesburg, South Africa; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Medicine, Rutgers University, Newark, NJ, USATB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USASummary: Background: Many individuals who survive tuberculosis disease face ongoing disability and elevated mortality risks. However, the impact of post-tuberculosis sequelae is generally omitted from policy analyses and disease burden estimates. We therefore estimated the global burden of tuberculosis, inclusive of post-tuberculosis morbidity and mortality. Methods: We constructed a hypothetical cohort of individuals developing tuberculosis in 2019, including pulmonary and extrapulmonary disease. We simulated lifetime health outcomes for this cohort, stratified by country, age, sex, HIV status, and treatment status. We used disability-adjusted life-years (DALYs) to summarise fatal and non-fatal health losses attributable to tuberculosis, during the disease episode and afterwards. We estimated post-tuberculosis mortality and morbidity based on the decreased lung function caused by pulmonary tuberculosis disease. Findings: Globally, we estimated 122 (95% uncertainty interval [UI] 98–151) million DALYs due to incident tuberculosis disease in 2019, with 58 (38–83) million DALYs attributed to post-tuberculosis sequelae, representing 47% (95% UI 37–57) of the total burden estimate. The increase in burden from post-tuberculosis varied substantially across countries and regions, driven largely by differences in estimated case fatality for the disease episode. We estimated 12·1 DALYs (95% UI 10·0–14·9) per incident tuberculosis case, of which 6·3 DALYs (5·6–7·0) were from the disease episode and 5·8 DALYs (3·8–8·3) were from post-tuberculosis. Per-case post-tuberculosis burden estimates were greater for younger individuals, and in countries with high incidence rates. The burden of post-tuberculosis was spread over the remaining lifetime of tuberculosis survivors, with almost a third of total DALYs (28%, 95% UI 23–34) accruing 15 or more years after incident tuberculosis. Interpretation: Post-tuberculosis sequelae add substantially to the overall disease burden caused by tuberculosis. This hitherto unquantified burden has been omitted from most previous policy analyses. Future policy analyses and burden estimates should take better account of post-tuberculosis, to avoid the potential misallocation of funding, political attention, and research effort resulting from continued neglect of this issue. Funding: National Institutes of Health.http://www.sciencedirect.com/science/article/pii/S2214109X21003673 |
| spellingShingle | Nicolas A Menzies, PhD Matthew Quaife, PhD Brian W Allwood, PhD Anthony L Byrne, PhD Anna K Coussens, PhD Anthony D Harries, ProfMD Florian M Marx, PhD Jamilah Meghji, PhD Debora Pedrazzoli, PhD Joshua A Salomon, ProfPhD Sedona Sweeney, PhD Sanne C van Kampen, PhD Robert S Wallis, ProfMD Rein M G J Houben, PhD Ted Cohen, ProfDPH Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae The Lancet Global Health |
| title | Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae |
| title_full | Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae |
| title_fullStr | Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae |
| title_full_unstemmed | Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae |
| title_short | Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae |
| title_sort | lifetime burden of disease due to incident tuberculosis a global reappraisal including post tuberculosis sequelae |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X21003673 |
| work_keys_str_mv | AT nicolasamenziesphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT matthewquaifephd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT brianwallwoodphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT anthonylbyrnephd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT annakcoussensphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT anthonydharriesprofmd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT florianmmarxphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT jamilahmeghjiphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT deborapedrazzoliphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT joshuaasalomonprofphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT sedonasweeneyphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT sannecvankampenphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT robertswallisprofmd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT reinmgjhoubenphd lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae AT tedcohenprofdph lifetimeburdenofdiseaseduetoincidenttuberculosisaglobalreappraisalincludingposttuberculosissequelae |