Influence of Sex and Sex-Based Disparities on Prevalent Tuberculosis, Vietnam, 2017–2018

Abstract

To assess sex disparities in tuberculosis in Vietnam, we conducted a nested, case–control study based on a 2017 tuberculosis prevalence survey. We defined the case group as all survey participants with laboratory–confirmed tuberculosis and the control group as a randomly selected group of participants with no tuberculosis. We used structural equation modeling to describe pathways from sex to tuberculosis according to an a priori conceptual framework. Our analysis included 1,319 participants, of whom 250 were case-patients. We found that sex was directly associated with tuberculosis prevalence (adjusted odds ratio for men compared with women 3.0 [95% CI 1.7–5.0]) and indirectly associated through other domains. The strong sex difference in tuberculosis prevalence is explained by a complex interplay of factors relating to behavioral and environmental risks, access to healthcare, and clinical manifestations. However, after controlling for all those factors, a direct sex effect remains that might be caused by biological factors.

Spatial Analysis of Drug-Susceptible and Multidrug-Resistant Cases of Tuberculosis, Ho Chi Minh City, Vietnam, 2020–2023

“…However, the magnitude of this difference in prevalence by sex is smaller for latent TB than for active TB, emphasizing the role of sex differences in risk factors for disease progression. A recent substudy from the national TB prevalence survey specifically noted the stark differences in the prevalence of smoking (45% of men vs. 1% of women) ( 31 ) and drinking (44% of men vs. 1% of women) ( 32 ) in Vietnam as likely contributors to observed differences in the prevalence of active TB by sex ( 33 ). Sex differences, for both latent and active disease, remain incompletely understood but likely reflect the complex interplay between biologic, behavioral, and environmental factors ( 34 ).…”