The global burden of tuberculosis: results from the Global Burden of Disease Study 2015

Background An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 ye...

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Autores:: Kyu, Hmwe H
Maddison, Emilie R
Henry, Nathaniel J
Mumford, John Everett
Barber, Ryan
Shields, Chloe
Brown, Jonathan C
Nguyen, Grant
Carter, Austin
Alvis-Guzman, Nelson

Tipo de recurso:: Article of journal

Fecha de publicación:: 2017

Institución:: Corporación Universidad de la Costa

Repositorio:: REDICUC - Repositorio CUC

Idioma:: eng

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dc.title.spa.fl_str_mv	The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
dc.title.translated.spa.fl_str_mv	La carga global de la tuberculosis: resultados del Estudio de la carga mundial de la enfermedad 2015
title	The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
spellingShingle	The global burden of tuberculosis: results from the Global Burden of Disease Study 2015 Tuberculosis Incidencia Prevalencia Mortalidad Tuberculosis Incidence Prevalence Mortality
title_short	The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
title_full	The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
title_fullStr	The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
title_full_unstemmed	The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
title_sort	The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
dc.creator.fl_str_mv	Kyu, Hmwe H Maddison, Emilie R Henry, Nathaniel J Mumford, John Everett Barber, Ryan Shields, Chloe Brown, Jonathan C Nguyen, Grant Carter, Austin Alvis-Guzman, Nelson
dc.contributor.author.spa.fl_str_mv	Kyu, Hmwe H Maddison, Emilie R Henry, Nathaniel J Mumford, John Everett Barber, Ryan Shields, Chloe Brown, Jonathan C Nguyen, Grant Carter, Austin Alvis-Guzman, Nelson
dc.subject.spa.fl_str_mv	Tuberculosis Incidencia Prevalencia Mortalidad Tuberculosis Incidence Prevalence Mortality
topic	Tuberculosis Incidencia Prevalencia Mortalidad Tuberculosis Incidence Prevalence Mortality
description	Background An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. Methods We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. Findings Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (–4·1% [–5·0 to –3·4]) than in incidence (–1·6% [–1·9 to –1·2]) and prevalence (–0·7% [–1·0 to –0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3–13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8–14·8), and smoking accounted for 7·8% (3·8–12·0). Interpretation Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis.
publishDate	2017
dc.date.issued.none.fl_str_mv	2017
dc.date.accessioned.none.fl_str_mv	2019-05-27T14:30:40Z
dc.date.available.none.fl_str_mv	2019-05-27T14:30:40Z
dc.type.spa.fl_str_mv	Artículo de revista
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dc.type.content.spa.fl_str_mv	Text
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dc.identifier.uri.spa.fl_str_mv	https://hdl.handle.net/11323/4722
dc.identifier.instname.spa.fl_str_mv	Corporación Universidad de la Costa
dc.identifier.reponame.spa.fl_str_mv	REDICUC - Repositorio CUC
dc.identifier.repourl.spa.fl_str_mv	https://repositorio.cuc.edu.co/
url	https://hdl.handle.net/11323/4722 https://repositorio.cuc.edu.co/
identifier_str_mv	Corporación Universidad de la Costa REDICUC - Repositorio CUC
dc.language.iso.none.fl_str_mv	eng
language	eng
dc.relation.ispartof.spa.fl_str_mv	DOI:https://doi.org/10.1016/S1473-3099(17)30703-X
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Systematic review and meta-analysis of the associations between indoor air pollution and tuberculosis. Trop Med Int Health 2013; 18: 101–08. 24 Food and Agriculture Organization of the UN. FAOSTAT statistics database. http://www.fao.org/faostat/en/?#data/FBS (accessed Sept 29, 2017). 25 WHO. WHO Global Health Observatory data repository. Global Information System on Alcohol and Health (GISAH). http://apps.who.int/gho/data/node.main.GISAH?lang=en (accessed March 1, 2016). 26 Global Health Data Exchange. http://ghdx.healthdata.org/search/ site/tobacco%20use (accessed Feb 16, 2016). 27 WHO. Tuberculosis financing and funding gaps. http://www.who.int/ tb/WHO_GF_TB_financing_factsheet.pdf (accessed Oct 14, 2016). 28 Dieleman J, Campbell M, Chapin A, et al. Evolution and patterns of global health financing 1995–2014. Lancet 2017; 389: 1981–2004. 29 Dye C. Tuberculosis 2000–2010: control, but not elimination. Int J Tuberc Lung Dis 2000; 4 (12 suppl 2): S146–52. 30 Sreeramareddy CT, Panduru KV, Menten J, Van den Ende J. Time delays in diagnosis of pulmonary tuberculosis: a systematic review of literature. BMC Infect Dis 2009; 9: 91. 31 Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health 2008; 8: 1. 32 Sreeramareddy CT, Qin ZZ, Satyanarayana S, Subbaraman R, Pai M. Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review. Int J Tuberc Lung Dis 2014; 18: 255–66. 33 Dye C, Williams BG. The population dynamics and control of tuberculosis. Science 2010; 328: 856–61. 34 Jochem K, Walley J. Determinants of the tuberculosis burden in populations. In: Porter JD, Grange JM, eds. Tuberculosis—an interdisciplinary perspective. London: Imperial College Press, 1999: 33–48. 35 Golub J, Bur S, Cronin W, et al. Delayed tuberculosis diagnosis and tuberculosis transmission. 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Evidence for waning of latency in a cohort study of tuberculosis. BMC Infect Dis 2010; 10: 37. 47 Comstock GW, Livesay VT, Woolpert SF. The prognosis of a positive tuberculin reaction in childhood and adolescence. Am J Epidemiol 1974; 99: 131–38. 48 Yee D, Valiquette C, Pelletier M, Parisien I, Rocher I, Menzies D. Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med 2003; 167: 1472–77. 49 Davies P. TB in the elderly in industrialised countries. Int J Tuberc Lung Dis 2007; 11: 1157–59. 50 Pratt RH, Winston CA, Kammerer JS, Armstrong LR. Tuberculosis in older adults in the United States, 1993–2008. J Am Geriatr Soc 2011; 59: 851–57. 51 Watkins R, Plant A. Does smoking explain sex differences in the global tuberculosis epidemic? Epidemiol Infect 2006; 134: 333–39. 52 Nhamoyebonde S, Leslie A. Biological differences between the sexes and susceptibility to tuberculosis. J Infect Dis 2014; 209 (suppl 3): S100–06. 53 Neyrolles O, Quintana-Murci L. Sexual inequality in tuberculosis. PLoS Med 2009; 6: e1000199. 54 Rehm J, Samokhvalov AV, Neuman MG, et al. The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health 2009; 9: 450. 55 Oeltmann JE, Kammerer JS, Pevzner ES, Moonan PK. Tuberculosis and substance abuse in the United States, 1997–2006. Arch Intern Med 2009; 169: 189–97 56 Rehm J, Baliunas D, Borges GL, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010; 105: 817–43. 57 Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis 2009; 9: 737–46. 58 Nelson S, Zhang P, Bagby GJ, Happel KI, Raasch CE. Alcohol abuse, immunosuppression, and pulmonary infection. Curr Drug Abuse Rev 2008; 1: 56–67. 59 O’Leary SM, Coleman MM, Chew WM, et al. Cigarette smoking impairs human pulmonary immunity to Mycobacterium tuberculosis. Am J Respir Crit Care Med 2014; 190: 1430–36. 60 Szabo G. Alcohol’s contribution to compromised immunity. Alcohol Health Res World 1997; 21: 30–41. 61 Uplekar M, Atre S, Wells WA, et al. Mandatory tuberculosis case notification in high tuberculosis-incidence countries: policy and practice. Eur Respir J 2016; 48: 1571–81. 62 Anderson L, Broekmans J, Floyd K, Glaziou P, Sismanidis B, Zignol M. Strengthening tuberculosis surveillance: rationale and proposed areas of work 2016–2020. http://www.who.int/tb/advisory_bodies/impact_ measurement_taskforce/meetings/tf6_background_2a_strengthening_ surveillance.pdf?ua=1 (accessed Sept 8, 2017). 63 Lopez A, Mikkelsen L, Rampatige R, et al. Strengthening civil registration and vital statistics for births, deaths and causes of death. Resource kit. Geneva: World Health Organization, 2013. 64 Abubakar I, Bassili A, Bierrenbach A, et al. Assessing tuberculosis under-reporting through inventory studies. Geneva: World Health Organization, 2012. 65 Begg S, Rao C, Lopez AD. Design options for sample-based mortality surveillance. Int J Epidemiol 2005; 34: 1080–87. 66 WHO. Global tuberculosis report 2015. Geneva: World Health Organization, 2015. 67 Dodd PJ, Sismanidis C, Seddon JA. Global burden of drug-resistant tuberculosis in children: a mathematical modelling study. Lancet Infect Dis 2016; 16: 1193–201. 68 Jenkins HE, Tolman AW, Yuen CM, et al. Incidence of multidrug-resistant tuberculosis disease in children: systematic review and global estimates. Lancet 2014; 383: 1572–79. 69 James SL, Flaxman AD, Murray CJ. Performance of the Tariff Method: validation of a simple additive algorithm for analysis of verbal autopsies. Popul Health Metr 2011; 9: 31. 70 Lozano R, Lopez AD, Atkinson C, Naghavi M, Flaxman AD, Murray CJ. Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards. Popul Health Metr 2011; 9: 32. 71 Murray CJ, Lozano R, Flaxman AD, et al. Using verbal autopsy to measure causes of death: the comparative performance of existing methods. BMC Med 2014; 12: 5. 72 Dowell SF, Blazes D, Desmond-Hellmann S. Four steps to precision public health. Nature 2016; 540: 189–91. 73 Cazabon D, Alsdurf H, Satyanarayana S, et al. Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade. Int J Infect Dis 2017; 56: 111–16.
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spelling	Kyu, Hmwe HMaddison, Emilie RHenry, Nathaniel JMumford, John EverettBarber, RyanShields, ChloeBrown, Jonathan CNguyen, GrantCarter, AustinAlvis-Guzman, Nelson2019-05-27T14:30:40Z2019-05-27T14:30:40Z2017https://hdl.handle.net/11323/4722Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Background An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. Methods We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. Findings Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (–4·1% [–5·0 to –3·4]) than in incidence (–1·6% [–1·9 to –1·2]) and prevalence (–0·7% [–1·0 to –0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3–13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8–14·8), and smoking accounted for 7·8% (3·8–12·0). Interpretation Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis.Antecedentes La comprensión de las tendencias en la incidencia, prevalencia y mortalidad de la tuberculosis es crucial para rastrear el éxito de los programas de control de la tuberculosis y para identificar los desafíos pendientes. En los últimos 25 años, evaluamos las tendencias en la carga fatal y no mortal de la tuberculosis en 195 países y territorios. Métodos Analizamos 10 691 años de datos vitales de registro, 768 años de datos de autopsias verbales y 361 años de datos de vigilancia de mortalidad utilizando el modelo de conjunto de causas de muerte para estimar las tasas de mortalidad por tuberculosis. Analizamos todas las fuentes de datos disponibles por edad y por sexo, incluidas las notificaciones anuales de casos, las encuestas de prevalencia y la mortalidad por causas específicas, para generar estimaciones coherentes internas de incidencia, prevalencia y mortalidad utilizando DisMod-MR 2.1, un meta bayesiano. - Herramienta de regresión. Se evaluó cómo la incidencia, la prevalencia y la mortalidad observadas de la tuberculosis difirieron de las tendencias esperadas según lo predice el Índice sociodemográfico (SDI), un indicador compuesto basado en el ingreso per cápita, el promedio de años de escolaridad y la tasa de fecundidad total. También estimamos la mortalidad por tuberculosis y los años de vida ajustados por discapacidad atribuibles a los efectos independientes de los factores de riesgo, como el tabaquismo, el consumo de alcohol y la diabetes. Hallazgos A nivel mundial, en 2015, el número de casos incidentes de tuberculosis (incluidos los casos nuevos y de recaída) fue de 10,2 millones (95% de intervalo de incertidumbre 9,2 millones a 11,5 millones), el número de casos prevalentes fue de 10 millones de casos. (9 · 2 millones a 11 · 1 millón), y el número de muertes fue de 1 · 3 millones (1 · 1 millón a 1 · 6 millones). Entre las personas con VIH negativo, el número de casos incidentes fue de 8,8 millones (8 millones a 9 9 millones), el número de casos prevalentes fue de 8,9 millones (8 millones a 9 millones de casos). y el número de muertes fue de 1 · 1 millón (0 · 9 millones a 1 · 4 millones). Las tasas de cambio anualizadas de 2005 a 2015 mostraron una disminución más rápida en la mortalidad (–4 · 1% [–5 · 0 a –3 · 4]) que en la incidencia (–1 · 6% [–1 · 9 a –1 · 2]) y prevalencia (–0 · 7% [–1 · 0 a –0 · 5]) entre individuos VIH negativos. La IDE se asoció inversamente con las tasas de mortalidad por VIH negativas, pero no mostró un gradiente claro para la incidencia y la prevalencia. La mayor parte de Asia, Europa oriental y África subsahariana tenían tasas más altas de carga de tuberculosis VIH-negativa de lo esperado, dada su IDE. El consumo de alcohol representó el 11 · 4% (9 · 3–13 · 0) de las muertes por tuberculosis en personas sin VIH en 2015, la diabetes representó el 10 · 6% (6 · 8–14 · 8) y el consumo de tabaco 7 · 8% (3 · 8–12 · 0).Kyu, Hmwe H-78087538-3de5-49cd-99ba-628bde154916-0Maddison, Emilie R-55da728b-6ed7-4186-9eab-24452677664d-0Henry, Nathaniel J-037e2d3b-5d44-45f7-8001-ffd412a8ab4e-0Mumford, John Everett-8805dbfb-b39b-4ebb-8508-94a0b345b658-0Barber, Ryan-82b6f25d-7276-44ff-8841-e30f05e54071-0Shields, Chloe-198b064e-0482-4070-a88f-1d58fef5185e-0Brown, Jonathan C-d43eac86-31e8-4e5a-a217-09e57a35f79d-0Nguyen, Grant-48a76e3f-d1c5-4e14-803f-3e826397462f-0Carter, Austin-b2f56492-8c67-4ddb-acad-e0f8f9a70830-0Alvis-Guzman, Nelson-5926771a-a351-4df4-86d8-05f67bd93051-0engThe LancetDOI:https://doi.org/10.1016/S1473-3099(17)30703-X1 Murray CJ, Ortblad KF, Guinovart C, et al. 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Int J Infect Dis 2017; 56: 111–16.Attribution-NonCommercial-ShareAlike 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2TuberculosisIncidenciaPrevalenciaMortalidadTuberculosisIncidencePrevalenceMortalityThe global burden of tuberculosis: results from the Global Burden of Disease Study 2015La carga global de la tuberculosis: resultados del Estudio de la carga mundial de la enfermedad 2015Artículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/acceptedVersionPublicationORIGINALThe global burden of tuberculosis results from the Global.pdfThe global burden of tuberculosis results from the Global.pdfapplication/pdf14610865https://repositorio.cuc.edu.co/bitstreams/439eb993-d8b6-4fdf-8296-58aec86e2a32/download67b5e9d2bbcc9b9670795a96f6e9b4d6MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-81031https://repositorio.cuc.edu.co/bitstreams/76806fe0-15ae-4bca-b29b-d8a3300b99c9/download934f4ca17e109e0a05eaeaba504d7ce4MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repositorio.cuc.edu.co/bitstreams/bca86749-e471-438b-8170-3b46b738fc08/download8a4605be74aa9ea9d79846c1fba20a33MD53THUMBNAILThe global burden of tuberculosis results from the Global.pdf.jpgThe global burden of tuberculosis results from the Global.pdf.jpgimage/jpeg72947https://repositorio.cuc.edu.co/bitstreams/c1c29e6d-8134-4f84-8004-909eb38e62d7/download296268c5c6f4b6957baf41a14b6c26c8MD55TEXTThe global burden of tuberculosis results from the Global.pdf.txtThe global burden of tuberculosis results from the Global.pdf.txttext/plain149151https://repositorio.cuc.edu.co/bitstreams/c4a8495e-9f52-4556-88e3-981f994a49ae/download0da11fabc06c03489895307abea24193MD5611323/4722oai:repositorio.cuc.edu.co:11323/47222024-09-17 10:59:01.662http://creativecommons.org/licenses/by-nc-sa/4.0/Attribution-NonCommercial-ShareAlike 4.0 Internationalopen.accesshttps://repositorio.cuc.edu.coRepositorio de la Universidad de la Costa CUCrepdigital@cuc.edu.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

The global burden of tuberculosis: results from the Global Burden of Disease Study 2015

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