Ironing out sex differences in tuberculosis prevalence

Yates, Tom A; Atkinson, Sarah H.

doi:10.5588/ijtld.17.0194

Cited by 18 publications

(22 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results suggest that some of the observed sex differences in tuberculosis burden in Peru could be attributable to disparities in access to care under programmatic passive case-finding, and not just differences between the sexes in exposure and susceptibility to tuberculosis. The globally observed predominance of tuberculosis among men has been attributed to increased exposure 20 or amplified susceptibility because of factors including larger lung volumes, sex hormones, and higher hepcidin levels 21, 22. In our study, variation of tuberculosis exposure by sex was minimised by studying household contacts of patients with infectious tuberculosis.…”

Section: Discussionmentioning

confidence: 96%

Active and passive case-finding in tuberculosis-affected households in Peru: a 10-year prospective cohort study

Saunders

Tovar

Collier

et al. 2019

The Lancet Infectious Diseases

View full text Add to dashboard Cite

Summary Background Active case-finding among contacts of patients with tuberculosis is a global health priority, but the effects of active versus passive case-finding are poorly characterised. We assessed the contribution of active versus passive case-finding to tuberculosis detection among contacts and compared sex and disease characteristics between contacts diagnosed through these strategies. Methods In shanty towns in Callao, Peru, we identified index patients with tuberculosis and followed up contacts aged 15 years or older for tuberculosis. All patients and contacts were offered free programmatic active case-finding entailing sputum smear microscopy and clinical assessment. Additionally, all contacts were offered intensified active case-finding with sputum smear and culture testing monthly for 6 months and then once every 4 years. Passive case-finding at local health facilities was ongoing throughout follow-up. Findings Between Oct 23, 2002, and May 26, 2006, we identified 2666 contacts, who were followed up until March 1, 2016. Median follow-up was 10·0 years (IQR 7·5–11·0). 232 (9%) of 2666 contacts were diagnosed with tuberculosis. The 2-year cumulative risk of tuberculosis was 4·6% (95% CI 3·5–5·5), and overall incidence was 0·98 cases (95% CI 0·86–1·10) per 100 person-years. 53 (23%) of 232 contacts with tuberculosis were diagnosed through active case-finding and 179 (77%) were identified through passive case-finding. During the first 6 months of the study, 23 (45%) of 51 contacts were diagnosed through active case-finding and 28 (55%) were identified through passive case-finding. Contacts diagnosed through active versus passive case-finding were more frequently female (36 [68%] of 53 vs 85 [47%] of 179; p=0·009), had a symptom duration of less than 15 days (nine [25%] of 36 vs ten [8%] of 127; p=0·03), and were more likely to be sputum smear-negative (33 [62%] of 53 vs 62 [35%] of 179; p=0·0003). Interpretation Although active case-finding made an important contribution to tuberculosis detection among contacts, passive case-finding detected most of the tuberculosis burden. Compared with passive case-finding, active case-finding was equitable, helped to diagnose tuberculosis earlier and usually before a positive result on sputum smear microscopy, and showed a high burden of undetected tuberculosis among women. Funding Wellcome Trust, Department for International Development Civil Society Challenge Fund, Joint Global Health Trials consortium, Bill & Melinda Gates Foundation, Imperial College National Institutes of Health Research Biomedical Research Centre, Foundation for Innovative New Diagnostics, Sir Halley Stewart Trust, WHO, TB REACH, and IFHAD: Innovation for Health and Development.

show abstract

Section: Discussionmentioning

confidence: 96%

Active and passive case-finding in tuberculosis-affected households in Peru: a 10-year prospective cohort study

Saunders

Tovar

Collier

et al. 2019

The Lancet Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…1 For the period 1970-2016 the age-standardised TB incidence rate per 100 000 people for men was nearly 1.8 times that of women (154.4 vs 86.3), and the TB mortality rate per 100 000 at least twice higher in men than women (21.9 vs 10.8). 6 Explanations for the sex differences in TB rates are complex and subject of debate, but tend to include possible differences in biology, [7][8][9] in risk-exposing behaviours and occupations, 10 in transmission dynamics, 11 or in health services access, use, diagnostic and reporting practices. 1 8 The accentuation of sex differences after childhood also suggests a role for environmental factors.…”

Section: Introductionmentioning

confidence: 99%

Missing men with tuberculosis: the need to address structural influences and implement targeted and multidimensional interventions

et al. 2020

View full text Add to dashboard Cite

Tuberculosis (TB) is treatable but is the leading infectious cause of death worldwide, with men over-represented in some key aspects of the disease burden. Men’s TB epidemiological scenario occurs within a wider public health and historical context, including their prior sidelining in health discussions. Differences are however noticeable in how some Western countries and high TB and HIV burden low and middle-income countries (LMIC) including in Africa have approached the subject(s) of men and health. The former have a comparatively long history of scholarship, and lately are implementing actions targeting men’s health and wellness, both increasingly addressing multilevel social and structural determinants. In contrast, in the latter men have received attention primarily for their sexual practices and role in HIV and AIDS and gender-based violence; moreover, interventions, guided by the public health approach, have stressed short-term, measurable and medical goals. Debates and the limited available empirical literature on men’s engagement with TB-related healthcare are nevertheless indicating need for a shift, within TB work with men in high burden LMICs towards, structural and multicomponent interventions.

show abstract

“…In females, bronchial tuberculosis with concurrent PTB was the strongest association rule (lift = 1.64).The proportion of bronchial tuberculosis with concurrent PTB in females was more than 55%. Cellular immunity, hormones, access to health care, socio-economic factors and cultural factors had been linked to these differences [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

The epidemiology and association rules of concurrent pulmonary tuberculosis and extrapulmonary tuberculosis (PTB-EPTB) in China: a large-scale multi- center observational study

Kang

Chang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Tuberculosis (TB) is a multi-systemic disease with a protean presentation and remains a major global health problem. Concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) are common in clinical practice. However, the information about concurrent PTB-EPTB is scarce. This study aimed to study the epidemiology of concurrent PTB-EPTB by summarizing the diagnostic types of TB and determine the association rules by a large-scale multi-center observational study in China.Methods The study was performed at 21 hospitals from 15 provinces in China. All the consecutive inpatient with confirmed TB diagnosis during the years from Jan 2011 to Dec 2017 was included in the study. The association rules of concurrent PTB-EPTB were analyzed by Apriori algorithm. Results Of 438,979 TB inpatients evaluated, the most common were PTB (82.05%), followed by tuberculous pleurisy (23.62%), etc. Concurrent PTB-EPTB occurred in 129,422 cases (29.48%). Concurrent PTB and tuberculous pleurisy was the most common concurrent PTB-EPTB types. In the fully adjusted multivariable logistic models, the odds ratio of concurrent PTB-EPTB was different by gender and age group. In PTB with concurrent EPTB, the strongest association rule was PTB with concurrent bronchial tuberculosis (lift=1.09). In EPTB with concurrent PTB, the strongest association rule was pharyngeal /laryngeal tuberculosis with concurrent PTB (lift=1.11). The confidence and lift of concurrent PTB-EPTB varied with gender and age. Conclusions There were many types of concurrent PTB-EPTB. The confidence and lift of concurrent PTB-EPTB varied with gender and age. The clinicians should be alert to the presence of concurrent PTB-EPTB and take effective treatment regimen.

show abstract

Ironing out sex differences in tuberculosis prevalence

Cited by 18 publications

References 14 publications

Active and passive case-finding in tuberculosis-affected households in Peru: a 10-year prospective cohort study

Active and passive case-finding in tuberculosis-affected households in Peru: a 10-year prospective cohort study

Missing men with tuberculosis: the need to address structural influences and implement targeted and multidimensional interventions

The epidemiology and association rules of concurrent pulmonary tuberculosis and extrapulmonary tuberculosis (PTB-EPTB) in China: a large-scale multi- center observational study

Contact Info

Product

Resources

About