Dodd Peter J, Yuen Courtney M, Jayasooriya Shamanthi M, van der Zalm Marieke M, Seddon James A
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Harvard Medical School, Harvard University, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
Lancet Infect Dis. 2021 Jul;21(7):984-992. doi: 10.1016/S1473-3099(20)30919-1. Epub 2021 Feb 25.
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.
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.
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.
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.
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.
结核病幸存者康复后面临临床和社会后果，包括结核病复发风险增加、过早死亡、肺功能下降以及持续的污名化。为描述这一问题的规模，我们旨在估计1980年至2019年间首次发生结核病的人数、存活至2020年的人数以及在过去5年或2年内接受治疗的人数。
在这项建模研究中，我们使用世界卫生组织国家层面的结核病病例通报数据估计接受治疗的结核病幸存者人数，不包括治疗期间死亡的患者。我们利用世界卫生组织国家层面发病率估计数与通报数之间的差值，并应用已发表的按年龄分层和按艾滋病毒分层的病死率，估计未经治疗的结核病幸存者人数。为估计随时间的生存率，利用《联合国世界人口展望2019》的死亡率和已发表的结核病后死亡风险比，为每个国家年份编制结核病后生命表。
1980年至2019年间，我们估计有3.63亿人（95%不确定区间[UI]2.87亿 - 4.38亿）发生结核病，其中1.72亿人（1.69亿 - 1.74亿）接受了治疗。1980年至2019年间发生结核病的个体到2020年在结核病后共存活34.8亿人年（95%UI 30.4亿 - 39.2亿），结核病发病时年龄小于15岁的幸存者贡献了这些人年的12%（95%UI 7 - 17）。我们估计2020年有1.55亿结核病幸存者（95%UI 1.38亿 - 1.71亿）存活，其中最大比例（47%[37 - 57]）在世卫组织东南亚区域。在2020年存活的结核病幸存者中，我们估计18%（95%UI 16 - 20）在过去5年接受了治疗，8%（7 - 9）在过去2年接受了治疗。
2020年存活的结核病幸存者人数是估计的年度结核病发病率的十多倍。应立即优先为近期接受治疗的结核病幸存者开展减轻呼吸疾病负担、筛查和预防结核病复发以及减少污名化的干预措施。
英国医学研究理事会、英国国际发展部、英国国家卫生研究院以及欧洲和发展中国家临床试验合作组织。
