Kumar Vijay, Nazli Khatib Mahalaqua, Verma Amit, Lakhanpal Sorabh, Ballal Suhas, Kumar Sanjay, Bhat Mahakshit, Sharma Aryantika, Ravi Kumar M, Sinha Aashna, Gaidhane Abhay M, Shabil Muhammed, Pratap Singh Mahendra, Sah Sanjit, Bhopte Kiran, Kundra Kamal, Kumar Samal Shailesh
Evidence for Policy and Learning, Global Center for Evidence Synthesis, Chandigarh, India.
Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
J Clin Tuberc Other Mycobact Dis. 2024 Oct 9;37:100480. doi: 10.1016/j.jctube.2024.100480. eCollection 2024 Dec.
Tuberculosis (TB) is a major public health issue in South Asia and accounts for a large share of the global TB burden. Despite global efforts to curb TB incidence and mortality, progress in South Asia has been uneven, necessitating focused regional analysis to guide effective interventions. This study aims to analyse the trends in the TB burden in South Asia from 1990 to 2021 and project future TB incidence rates up to 2031.
This study utilized data from the Global Burden of Disease (GBD) 2021 results to analyse trends in age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) rates (ASDR) associated with TB in South Asia from 1990 to 2021. Joinpoint regression analysis was employed to identify significant trends, whereas ARIMA models were used to project future TB incidence rates up to 2031.
This study revealed significant declines in the ASIR, ASPR, ASDR, and ASMR related to TB in South Asia over the past three decades. Prominent reductions were found in Bangladesh and Bhutan, whereas India, Pakistan, and Nepal continue to bear the highest TB burdens. The ARIMA model projections indicate a continued decline in TB incidence across the region, although the extent of the decline varies by country, with less favourable trends observed in Nepal and Pakistan. The analysis also highlights tobacco use, high fasting plasma glucose, and high body mass index as significant risk factors contributing to the TB burden.
Substantial progress has been made in reducing the TB burden in South Asia; however, sustained and intensified efforts are needed, particularly in countries with inconsistent progress. These findings emphasize the need for targeted interventions to meet the WHO End TB Strategy (WETS) targets by 2035. Continuous monitoring and adaptive strategies will be crucial in maintaining and accelerating progress toward TB elimination in South Asia.
结核病是南亚地区的一个主要公共卫生问题，在全球结核病负担中占很大比例。尽管全球致力于遏制结核病发病率和死亡率，但南亚地区的进展并不均衡，因此需要进行有针对性的区域分析，以指导有效的干预措施。本研究旨在分析1990年至2021年南亚地区结核病负担的趋势，并预测到2031年的未来结核病发病率。
本研究利用全球疾病负担（GBD）2021年结果的数据，分析了1990年至2021年南亚地区与结核病相关的年龄标准化发病率（ASIR）、患病率（ASPR）、死亡率（ASMR）和伤残调整生命年（DALYs）率（ASDR）的趋势。采用Joinpoint回归分析来确定显著趋势，而ARIMA模型则用于预测到2031年的未来结核病发病率。
本研究显示，在过去三十年中，南亚地区与结核病相关的ASIR、ASPR、ASDR和ASMR显著下降。孟加拉国和不丹的降幅显著，而印度、巴基斯坦和尼泊尔仍然承担着最高的结核病负担。ARIMA模型预测表明，该地区结核病发病率将持续下降，尽管下降幅度因国家而异，尼泊尔和巴基斯坦的趋势不太乐观。分析还强调，吸烟、高空腹血糖和高体重指数是导致结核病负担的重要风险因素。
南亚地区在减轻结核病负担方面取得了重大进展；然而，仍需要持续和强化努力，特别是在进展不一致的国家。这些发现强调了采取有针对性的干预措施以实现世界卫生组织终止结核病战略（WETS）到2035年目标的必要性。持续监测和适应性策略对于在南亚维持和加速结核病消除进程至关重要。
