Can Melike Hazal, Sweeney Sedona, Allwood Brian W, Dorman Susan E, Cohen Ted, Menzies Nicolas A
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
medRxiv. 2024 Aug 17:2024.08.12.24311198. doi: 10.1101/2024.08.12.24311198.
Untreated pulmonary tuberculosis (TB) causes ongoing lung damage, which may persist after treatment. Conventional approaches for assessing TB health effects may not fully capture these mechanisms. We evaluated how TB-associated lung damage and post-TB sequalae affect the lifetime health consequences of TB in high HIV prevalence settings.
We developed a microsimulation model representing dynamic changes in lung function for individuals evaluated for TB in routine clinical settings. We parameterized the model with data for Uganda, Kenya, and South Africa, and estimated lifetime health outcomes under prompt, delayed, and no TB treatment scenarios. We compared results to earlier modelling approaches that omit progressive lung damage and post-TB sequelae.
We estimated 4.6 (95% uncertainty interval 3.4-5.8), 7.2 (5.1-9.6), and 18.0 (15.1-20.0) year reductions in life expectancy due to TB under prompt, delayed, and no treatment scenarios, respectively. Disability-adjusted life years (DALYs) from TB were estimated as 8.3 (6.2-10.6), 12.6 (9.0-17.0), and 27.8 (24.1-30.6) under prompt, delayed, and no treatment scenarios, respectively. Post-TB DALYs represented 9-53% of total DALYs. Modelling approaches that omit progressive lung damage and post-TB sequelae underestimated lifetime health losses of TB by 48-57%, and underestimated the benefits of prompt treatment by 45-64%.
Delayed initiation of TB treatment causes greater lung damage and higher mortality risks during and after the disease episode. In settings with co-prevalent TB and HIV, accounting for these factors substantially increased estimates of the lifetime disease burden and life expectancy loss caused by TB.
NIH.
未经治疗的肺结核会持续对肺部造成损害，这种损害在治疗后可能依然存在。评估结核病对健康影响的传统方法可能无法完全捕捉这些机制。我们评估了在艾滋病毒高流行地区，结核病相关的肺部损害和结核病后遗症如何影响结核病对一生健康的后果。
我们开发了一个微观模拟模型，该模型代表了在常规临床环境中接受结核病评估的个体肺功能的动态变化。我们用乌干达、肯尼亚和南非的数据对模型进行参数化，并估计了在及时治疗、延迟治疗和不进行结核病治疗的情况下一生的健康结果。我们将结果与早期忽略进行性肺损伤和结核病后遗症的建模方法进行了比较。
我们估计，在及时治疗、延迟治疗和不治疗的情况下，结核病导致的预期寿命分别减少4.6年（95%不确定区间3.4 - 5.8年）、7.2年（5.1 - 9.6年）和18.0年（15.1 - 20.0年）。在及时治疗、延迟治疗和不治疗的情况下，结核病导致的伤残调整生命年（DALYs）分别估计为8.3（6.2 - 10.6）、12.6（9.0 - 17.0）和27.8（24.1 - 30.6）。结核病后的DALYs占总DALYs的9% - 53%。忽略进行性肺损伤和结核病后遗症的建模方法将结核病一生的健康损失低估了48% - 57%，并将及时治疗的益处低估了45% - 64%。
延迟开始结核病治疗会在疾病发作期间和之后造成更大的肺部损害和更高的死亡风险。在结核病和艾滋病毒共同流行的地区，考虑这些因素会大幅增加对结核病导致的一生疾病负担和预期寿命损失的估计。
美国国立卫生研究院
