Post-tuberculosis mortality and morbidity: valuing the hidden epidemic

Quaife, Matthew; Houben, Rein M. G. J.; Allwood, Brian; Cohen, Ted; Coussens, Anna K.; Harries, Anthony; Kampen, Sanne van; Marx, Florian M.; Sweeney, Sedona; Wallis, Robert S.; Menzies, Nicolas A

doi:10.1016/s2213-2600(20)30039-4

Cited by 56 publications

(43 citation statements)

References 12 publications

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“…Post-TB physical morbidity is increasingly recognised as a key component of the overall number of disability-adjusted and quality-adjusted lifeyears lost in relation to TB disease, 24 and our findings suggest that its impact on long-term productivity and financial vulnerability should also be considered. 25 Recurrent TB disease may also be detrimental to this group: socioeconomic outcomes among those receiving TB retreatment were poor in this study, but our ability to explore this finding was limited by the low numbers of retreatment patients identified, and further work is needed in this area.…”

Section: Discussionmentioning

confidence: 88%

The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting

Meghji

Gregorius

Madan

et al. 2020

Thorax

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BackgroundMitigating the socioeconomic impact of tuberculosis (TB) is key to the WHO End TB Strategy. However, little known about socioeconomic well-being beyond TB-treatment completion. In this mixed-methods study, we describe socioeconomic outcomes after TB-disease in urban Blantyre, Malawi, and explore pathways and barriers to financial recovery.MethodsAdults ≥15 years successfully completing treatment for a first episode of pulmonary TB under the National TB Control Programme were prospectively followed up for 12 months. Socioeconomic, income, occupation, health seeking and cost data were collected. Determinants and impacts of ongoing financial hardship were explored through illness narrative interviews with purposively selected participants.Results405 participants were recruited from February 2016 to April 2017. Median age was 35 years (IQR: 28–41), 67.9% (275/405) were male, and 60.6% (244/405) were HIV-positive. Employment and incomes were lowest at TB-treatment completion, with limited recovery in the following year: fewer people were in paid work (63.0% (232/368) vs 72.4% (293/405), p=0.006), median incomes were lower (US$44.13 (IQR: US$0–US$106.15) vs US$72.20 (IQR: US$26.71–US$173.29), p<0.001), and more patients were living in poverty (earning <US$1.90/day: 57.7% (211/366) vs 41.6% (166/399), p<0.001) 1 year after TB-treatment completion compared with before TB-disease onset. Half of the participants (50.5%, 184/368) reported ongoing dissaving (use of savings, selling assets, borrowing money) and 9.5% (35/368) reported school interruptions in the year after TB-treatment completion. Twenty-one participants completed in-depth interviews. Reported barriers to economic recovery included financial insecurity, challenges rebuilding business relationships, residual physical morbidity and stigma.ConclusionsTB-affected households remain economically vulnerable even after TB-treatment completion, with limited recovery in income and employment, persistent financial strain requiring dissaving, and ongoing school interruptions. Measures of the economic impact of TB disease should include the post-TB period. Interventions to protect the long-term health and livelihoods of TB survivors must be explored.

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Section: Discussionmentioning

confidence: 88%

The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting

Meghji

Gregorius

Madan

et al. 2020

Thorax

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“…Achieving a fourth 90, "[e]nsuring that 90% of all people successfully completing treatment for TB can have a good health-related quality of life" [4], requires addressing post-TB airway disease [16]. Moreover, post-TB airway disease has a substantial health economic impact in terms of DALY estimates [45], in which acute-illness and mortality-based methods for assessing TB's impact accounted for only a quarter of estimated DALYs when chronic lung impairment was incorporated in DALY calculation in a low-TB-incidence setting [46]. Given our findings, along with data showing similar associations from other high-resource settings [13,14,47], we strongly urge investment in the diagnosis of post-TB airway disease, and research on potential evidence-based interventions [25], as well as a health economic re-evaluation of latent TB screening and treatment, in low-TB-incidence settings.…”

Section: Discussionmentioning

confidence: 99%

Post-tuberculosis airway disease: A population-based cohort study of people immigrating to British Columbia, Canada, 1985–2015

et al. 2021

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Background: Current epidemiological evidence of post-TB airway disease is largely cross-sectional and derived from high-TB-incidence settings. We present the first cohort study of post-TB airway disease in a low-TB-incidence setting. ( 1) analyze the risk of airway disease by respiratory TB, (2) assess potential unmeasured confounding between TB and airway disease, and (3) investigate TB effect measure modification. Methods: A population-based cohort study using healthcare claims data for immigrants to British Columbia (BC), Canada, 1985À2015. Airway disease included chronic airway obstruction, asthma, bronchitis, bronchiolitis, and emphysema. Respiratory TB was defined from TB registry data. Cox proportional hazards (PH) regressions were used to analyze time-to-airway disease by respiratory TB. Sensitivity analyses included varying definitions of TB and airway disease. Potential unmeasured confounding by smoking was evaluated by E-value and hybrid least absolute shrinkage and selection operator (LASSO)-high-dimensional propensity score (hdPS). Findings: In our cohort (N = 1 005 328; n TB =1141) there were 116 840 incident cases of airway disease during our 30-year study period (10.43 per 1,000 person-years of follow-up), with cumulative incidence of 42¢5% among respiratory TB patients compared with 11¢6% among non-TB controls. The covariate-adjusted hazard ratio (aHR) for airway disease by respiratory TB was 2¢08 (95% CI: 1¢91À2¢28) with E-value=3¢58. The LASSO-hdPS analysis produced aHR=2¢26 (95% CI: 2¢07À2¢47). Interpretation: A twofold higher risk of airway disease was observed among immigrants diagnosed with respiratory TB, compared with non-TB controls, in a low-TB-incidence setting. Unmeasured confounding is unlikely to explain this relationship. Models of post-TB care are needed.

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“…In a recent meta-analysis, persons previously treated for TB were found to be 2 to 5 times more likely to die compared to the general population or matched controls [ 5 ]. The excess mortality among these individuals has been attributed to the increased risk of recurrent TB, as well as related communicable and noncommunicable diseases [ 3 , 5 – 7 ].…”

Section: Are These Lives Saved Forever?mentioning

confidence: 99%

Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern

Bongomin

2020

PLoS Pathog

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How common is CPA after treated PTB? CPA is a progressive respiratory syndrome that largely occur in immunocompetent or subtly immunocompromised individuals with underlying structural lung diseases, most commonly treated TB [11]. Residual cavities remain in between 20% to 40% of lungs of patients following treatment for PTB [12,13]. Cavitation and ectatic lesions in PTBLD allows saprophytic colonisation and growth of Aspergillus species following inhalation of infectious spores from the environment. This leads to expansion of the existing or creation of new cavities with associated parenchymal and pleural damage [11]. A complex mixture of Aspergillus hyphae, tissue debris, inflammatory cells, and mucin known as a fungal ball (aspergilloma) may form in these cavities [11]. The significance of treated PTB in the pathogenesis of CPA was established by a large cohort study across over 50 clinics in Great Britain in the mid-to late 1960s [14]. In this landmark study, 544 patients who had a persistent cavity of at least 2.5 cm in diameter and negative M. tuberculosis bacilli in their sputum for at least a year were studied. About 25% of the patients had positive Aspergillus precipitins (i.e., precipitating immunoglobulin M [IgM] and immunoglobulin G

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Post-tuberculosis mortality and morbidity: valuing the hidden epidemic

Cited by 56 publications

References 12 publications

The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting

The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting

Post-tuberculosis airway disease: A population-based cohort study of people immigrating to British Columbia, Canada, 1985–2015

Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern

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