Gender-age peculiarities of disability-adjusted life years (DALYs) in tuberculosis in a high-density region: a retrospective cohort study

Abstract

Background. Infections associated with socially significant diseases considerably contribute to a decrease in the quality of public health. Tuberculosis, though declining in Russia, is still recognized as a pressing public health problem. Meanwhile, an assessment of the burden of tuberculosis on society, using such comprehensive methods as measuring disability-adjusted life years, is yet to be investigated in Russia. Objective. To estimate the tuberculosis burden by calculating the index of disability adjusted life years in a high-density region.Methods. The retrospective cohort study involved data on newly-diagnosed and died of tuberculosis cases that corresponded to the annual reporting form of federal statistical surveillance No. 8 “Information on active tuberculosis cases” for the Republic of North Ossetia-Alania; information on patients who died of tuberculosis or tuberculosis combined with infection caused by human immunodeficiency virus, was obtained from the Department of Civil Status Records of the Republic of North Ossetia-Alania and verified with data from the Federal State Statistics Service; data on tuberculosis-associated disability was received from Main Bureau of Medical and Social Expertise in the Republic of North Ossetia-Alania of the Ministry of Labor and Social Protection of the Russian Federation for 2018 and 2022. Following the analytic dataset, 691 people with newly-diagnosed tuberculosis, who received TB-associated disability and died from TB in 2018 (318 people) and 2022 (373 people) were identified. The study involved calculation of gender and age standardized TB morbidity and mortality rates as well as DALY index with its components: Years of Life Lost due to tuberculosis and Years Lost due to Disability. The study involved comparing data between 2018 and 2022 and gender/age-specific indicators within the same year. Mathematical data processing was performed using Microsoft Excel 2017 (Microsoft Corporation, USA) and SPSS 26.0 (SPSS Inc., USA). Differences between the compared indicators were evaluated by Chi-square criterion with variations, the initial data were grouped in a contingency table, the significance of differences was expressed by p-value.Results. The burden of tuberculosis in the Republic of North Ossetia-Alania refers predominantly to the male population: with a gender difference in the decrease in the disability-adjusted life years in 2018 and 2022 by 4.4 and 9.0 times (p < 0.05), respectively; 2.8 times among males, 5.5 times among females (p < 0.05). The burden of tuberculosis is mainly associated with premature mortality due to tuberculosis among males aged 35–54 years and among females aged 35–44 years with a pronounced decrease in Years of Life Lost. Years of Life Lost among males aged 20–34 in 2022 appears two times higher than the cohort average. The increase in Years of Life Lost among males aged 60–64 accounted for 1.7 times, in Years Lost Due to Disability — 11.2 times (p < 0.05). Years Lost Due to Disability among females aged 20–44 years appeared to be the highest, exceeding the cohort average by more than two times in 2018.Conclusion. The burden of tuberculosis is predominantly due to tuberculosis-related premature mortality among the male population. According to the disturbing conclusion, Years of Life Lost among young males aged 20–34 years and tuberculosis-related premature mortality shift towards the male population of pre-retirement age (60–64 years) with an increase in Years Lost Due to Disability among them. Notably, the study reveals high rates of Years Lost Due to Disability among females aged 20–44. The results obtained should be taken into account when developing regional tuberculosis programs with their targeted use in “vulnerable” age and gender groups of the population.