Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

Abstract

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries: a meta-review

“…Given the fact that multimorbidity is common in LMICs35 36 and is associated with a wide range of adverse outcomes for the individual, family and society, and poses challenges for healthcare systems, particularly in LMICs, our results are important 37 38. TB multimorbidity appears to be common and to have additional burdensome impact, deserving urgent attention 15 39. Research is needed to identify early at-risk populations and ultimately prevent the onset of TB multimorbidity and to develop effective treatments and clinical pathways to care for this heterogeneous and burdensome group of people 15.…”

Gender differences in tuberculosis patients with comorbidity: A cross-sectional study using national surveillance data and national health insurance claims data in South Korea

“…Tuberculosis (TB) is an infectious disease that remains the leading cause of death [1], and its control is a major concern worldwide [2,3]. Furthermore, the high prevalence of multimorbidity in patients with TB is one of the main obstacles to its management [4,5]. The coexistence of TB and chronic diseases should be considered a serious public health issue because they can affect the treatment efficacy and health of patients and their subsequent well-being and quality of life in general.…”

“…Although NCD multimorbidity among patients with TB is well known, relevant empirical studies have been conducted only in low-and middle-income countries with a high incidence of TB and mortality rates [5,[20][21][22][23]. As part of such efforts, the present study examined comorbidities at the time of TB onset in individuals in Korea.…”

Hepatitis B Virus and Tuberculosis Are Associated with Increased Noncommunicable Disease Risk among Treatment-Naïve People with HIV: Opportunities for Prevention, Early Detection and Management of Comorbidities in Sierra Leone

“…However, there is limited research on the prevalence, correlates and pathogenesis of NCDs among PWH in LMICs. While a heightened proinflammatory state and immune dysregulation induced by coinfections such as viral hepatitis [ 13 ] and TB [ 14 ] have been suggested as possible risk factors in endemic settings, their relative contributions to the pathogenesis of NCDs have not been quantified.…”