Infectious Diseases Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine - Qatar, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, USA.
Population Health Research Institute, St George's, University of London, London, UK.
Tuberculosis (Edinb). 2022 May;134:102164. doi: 10.1016/j.tube.2022.102164. Epub 2022 Jan 31.
We investigated and forecasted the impact of diabetes mellitus (DM) on tuberculosis (TB) epidemiology in Indonesia between 2020 and 2050. A recently-developed age-structured TB-DM dynamic mathematical model was utilized to assess the impact of DM on TB epidemiology. Model parameters were informed by systematic reviews and meta-analyses. Sensitivity and uncertainty analyses were conducted to assess robustness of predictions. The proportion of TB incident cases attributed to DM increased from 18.8% (95% uncertainty interval (UI): 12.6%-24.3%) in 2020, to 20.9% (95% UI: 14.7%-27.1%) in 2030, and 25.8% (95% UI: 17.7%-32.2%) in 2050. The proportion of TB-related deaths attributed to DM increased from 24.3% (95% UI: 18.7%-29.1%) in 2020, to 27.7% (95% UI: 22.4%-32.4%) in 2030, and 34.3% (95% UI: 27.6%-38.0%) in 2050. Most of the impact of DM on TB transmission has risen because of faster progression to TB disease, increased risk of reinfection, and increased infectiousness, with higher bacterial loads. Sensitivity and uncertainty analyses affirmed the predictions. TB-DM synergy is projected to increase in Indonesia over the next three decades with DM becoming a major driver of TB incidence and deaths. Joint TB-DM management and programs could offer significant reductions in TB incidence and mortality, making post-2015 End TB targets more feasible.
我们研究并预测了 2020 年至 2050 年期间糖尿病（DM）对印度尼西亚结核病（TB）流行病学的影响。使用新开发的年龄结构 TB-DM 动态数学模型来评估 DM 对 TB 流行病学的影响。模型参数由系统评价和荟萃分析提供信息。进行了敏感性和不确定性分析，以评估预测的稳健性。归因于 DM 的 TB 发病例的比例从 2020 年的 18.8%（95%置信区间（UI）：12.6%-24.3%）增加到 2030 年的 20.9%（95% UI：14.7%-27.1%），并在 2050 年增加到 25.8%（95% UI：17.7%-32.2%）。归因于 DM 的 TB 相关死亡比例从 2020 年的 24.3%（95% UI：18.7%-29.1%）增加到 2030 年的 27.7%（95% UI：22.4%-32.4%），并在 2050 年增加到 34.3%（95% UI：27.6%-38.0%）。DM 对 TB 传播的影响增加主要是由于向 TB 疾病的更快进展、再感染风险增加以及更高的细菌负荷导致的传染性增加。敏感性和不确定性分析证实了这些预测。预计在未来三十年中，印度尼西亚的 TB-DM 协同作用将增加，DM 将成为 TB 发病率和死亡率的主要驱动因素。TB-DM 联合管理和方案可以显著降低 TB 的发病率和死亡率，使 2015 年后终结结核病目标更加可行。
