Background
Previous studies have shown gender differences in tuberculosis (TB) incidence, however, gender disparity has not been well documented across granular categorizations of anatomic sites affected by TB and in the presence of HIV coinfection, largely due to small sample size for less common TB clinical presentations and lack of detailed clinical data.
Methods
The study population included TB cases aged ≥15 years (n = 41, 266) diagnosed in Harare, Zimbabwe. This cross-sectional study estimated male-to-female ratio (M:F ratio) for: i) age-specific TB incidence, ii) age-specific HIV prevalence among incident TB cases, and iii) nine types of TB defined by affected anatomic site.
Results
Males were at a 53% higher risk of TB compared to females (Risk Ratio (RR) = 1.53,95% CI: 1.12, 2.09). Based on multinomial logistic regression model, adjusted odds ratios for abdominal TB (aOR = 0.51,95% CI: 0.39, 0.68), TB bones/joints/spine (aOR = 0.63,95% CI: 0.45, 0.90) and ‘other’ extra-pulmonary TB sites (aOR = 0.69,95% CI = 0.59,0.81) vs pulmonary TB were lower among males compared to females. The risk of TB-HIV coinfection among males was 17% (RR = 0.83, 95% CI: 0.74, 0.93) and 8% (RR = 0.92, 95% CI: 0.88,0.95) lower in the 15-24 year and 25-44 year age groups respectively.
Conclusions
This study revealed a nuanced role of gender across finer categorizations of TB, indicating the need for future research to delineate underlying mechanisms driving gender disparities in TB. The finding that women had a greater likelihood of severe forms of TB and TB-HIV coinfection compared to men has important implications for women’s health in TB-HIV high burden settings.