Swartwood Nicole A, Cohen Ted, Marks Suzanne M, Hill Andrew N, Asay Garrett R Beeler, Self Julie, Feng Pei-Jean I, Horsburgh C Robert, Salomon Joshua A, Menzies Nicolas A
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT.
medRxiv. 2024 Oct 18:2024.10.17.24315683. doi: 10.1101/2024.10.17.24315683.
Tuberculosis (TB) cases and deaths in the United States fluctuated substantially during the COVID-19 pandemic. We analyzed multiple data sources to understand the factors contributing to these changes and estimated future TB trends.
We identified four mechanisms potentially contributing to observed TB trends during 2020-2023: immigration, respiratory contact rates, rates of accurate diagnosis and treatment initiation, and mortality rates for persons with TB disease. We employed a Bayesian approach to synthesize evidence on how these mechanisms changed during the pandemic and how they might have combined to produce observed 2020-2023 TB data, using a transmission-dynamic model to link mechanisms to TB outcomes. We also simulated a no-pandemic counterfactual scenario that assumed mechanisms followed pre-pandemic trends. We estimated TB outcomes associated with the pandemic until 2035 to capture lagged effects. We evaluated additional scenarios to estimate the individual effect of each mechanism.
Over the 2020-2035 study period, we estimate an additional 2,784 (95% uncertainty interval: 2,164-3,461) TB cases and 1,138 (1,076-1,201) TB deaths in the United States associated with changes occurring during the COVID-19 pandemic. The four mechanisms had offsetting effects - decreases in TB diagnosis rates and increases in TB mortality rates led to more TB deaths, while reductions in contact rates reduced TB deaths. Immigration changes initially reduced TB deaths, but increased deaths over time.
While the direct impacts of the COVID-19 pandemic occurred between 2020-2023, these changes may continue to influence TB incidence and mortality in future years.
在美国，结核病（TB）病例数和死亡数在新冠疫情期间大幅波动。我们分析了多个数据源，以了解导致这些变化的因素，并估计未来结核病趋势。
我们确定了四种可能导致2020年至2023年期间观察到的结核病趋势的机制：移民、呼吸道接触率、准确诊断和开始治疗的比率，以及结核病患者的死亡率。我们采用贝叶斯方法，综合关于这些机制在疫情期间如何变化以及它们如何结合产生2020年至2023年观察到的结核病数据的证据，使用传播动力学模型将机制与结核病结果联系起来。我们还模拟了一个无疫情的反事实情景，该情景假设机制遵循疫情前的趋势。我们估计了与疫情相关的结核病结果，直至2035年，以捕捉滞后效应。我们评估了其他情景，以估计每种机制的个体效应。
在2020年至2035年的研究期间，我们估计美国因新冠疫情期间发生的变化而额外出现2784例（95%不确定区间：2164 - 3461例）结核病病例和1138例（1076 - 1201例）结核病死亡。这四种机制具有抵消作用——结核病诊断率下降和结核病死亡率上升导致更多结核病死亡，而接触率降低则减少了结核病死亡。移民变化最初减少了结核病死亡，但随着时间推移死亡人数增加。
虽然新冠疫情的直接影响发生在2020年至2023年之间，但这些变化可能在未来几年继续影响结核病发病率和死亡率。
