Liu Yiran E, Mabene Yasmine, Camelo Sergio, Rueda Zulma Vanessa, Pelissari Daniele Maria, Johansen Fernanda Dockhorn Costa, Huaman Moises A, Avalos-Cruz Tatiana, Alarcón Valentina A, Ladutke Lawrence M, Bergman Marcelo, Cohen Ted, Goldhaber-Fiebert Jeremy D, Croda Julio, Andrews Jason R
Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA.
Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
medRxiv. 2024 Jul 22:2024.04.23.24306238. doi: 10.1101/2024.04.23.24306238.
Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. The full impact of incarceration on the tuberculosis epidemic, accounting for effects beyond prisons, has never been quantified.
We calibrated dynamic compartmental transmission models to historical and contemporary data from Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru, which comprise approximately 80% of the region's incarcerated population and tuberculosis burden. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the impact of alternative incarceration policies on future population tuberculosis incidence.
Population tuberculosis incidence in 2019 was 29.4% (95% UI, 23.9-36.8) higher than expected without the rise in incarceration since 1990, corresponding to 34,393 (95% UI, 28,295-42,579) excess incident cases across countries. The incarceration tPAF in 2019 was 27.2% (95% UI, 20.9-35.8), exceeding estimates for other risk factors like HIV, alcohol use disorder, and undernutrition. Compared to a scenario where incarceration rates remain stable at current levels, a gradual 50% reduction in prison admissions and duration of incarceration by 2034 would reduce population tuberculosis incidence by over 10% in all countries except Mexico.
The historical rise in incarceration in Latin America has resulted in a large excess tuberculosis burden that has been under-recognized to-date. International health agencies, ministries of justice, and national tuberculosis programs should collaborate to address this health crisis with comprehensive strategies, including decarceration.
National Institutes of Health.
拉丁美洲的结核病发病率正在上升，自1990年以来，该地区的监禁人口几乎增加了两倍。监禁对结核病流行的全面影响，包括监狱以外的影响，从未得到量化。
我们将动态 compartmental 传播模型校准到来自阿根廷、巴西、哥伦比亚、萨尔瓦多、墨西哥和秘鲁的历史和当代数据，这些国家约占该地区监禁人口和结核病负担的80%。利用历史反事实情景，我们估计了监禁的传播人群归因分数（tPAF）以及自1990年以来监禁患病率上升导致的额外人群水平负担。我们还预测了替代监禁政策对未来人群结核病发病率的影响。
2019年人群结核病发病率比1990年以来监禁率未上升时的预期高出29.4%（95%UI，23.9 - 36.8），相当于各国共有34,393例（95%UI，28,295 - 42,579）额外发病病例。2019年监禁的tPAF为27.2%（95%UI，20.9 - 35.8），超过了对艾滋病毒、酒精使用障碍和营养不良等其他风险因素的估计。与监禁率保持在当前水平稳定的情景相比，到2034年监狱收容人数和监禁时间逐步减少50%，除墨西哥外的所有国家人群结核病发病率将降低超过10%。
拉丁美洲监禁率的历史上升导致了大量未被充分认识的额外结核病负担。国际卫生机构、司法部和国家结核病项目应合作，通过包括非监禁化在内的综合战略来应对这一健康危机。
美国国立卫生研究院
