The global burden of tuberculosis: results from the Global Burden of Disease Study 2015

GBD Tuberculosis Collaborators

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background: An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. Methods: We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. Findings: Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (−4·1% [−5·0 to −3·4]) than in incidence (−1·6% [−1·9 to −1·2]) and prevalence (−0·7% [−1·0 to −0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3–13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8–14·8), and smoking accounted for 7·8% (3·8–12·0). Interpretation: Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis. Funding: Bill & Melinda Gates Foundation.

Original languageEnglish
Pages (from-to)261-284
Number of pages24
JournalThe Lancet Infectious Diseases
Volume18
Issue number3
DOIs
Publication statusPublished - 2018 Mar 1

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Tuberculosis
Mortality
HIV
Incidence
Smoking
Alcohols
Demography
Global Burden of Disease
Eastern Europe
Quality-Adjusted Life Years
Africa South of the Sahara
Quality of Health Care
Birth Rate
Information Storage and Retrieval
Uncertainty
Cause of Death
Autopsy
Recurrence

ASJC Scopus subject areas

  • Infectious Diseases

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The global burden of tuberculosis : results from the Global Burden of Disease Study 2015. / GBD Tuberculosis Collaborators.

In: The Lancet Infectious Diseases, Vol. 18, No. 3, 01.03.2018, p. 261-284.

Research output: Contribution to journalArticle

@article{d3794cd5745349429aab65af59ffc853,
title = "The global burden of tuberculosis: results from the Global Burden of Disease Study 2015",
abstract = "Background: An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. Methods: We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. Findings: Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95{\%} uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (−4·1{\%} [−5·0 to −3·4]) than in incidence (−1·6{\%} [−1·9 to −1·2]) and prevalence (−0·7{\%} [−1·0 to −0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4{\%} (9·3–13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6{\%} (6·8–14·8), and smoking accounted for 7·8{\%} (3·8–12·0). Interpretation: Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis. Funding: Bill & Melinda Gates Foundation.",
author = "{GBD Tuberculosis Collaborators} and Kyu, {Hmwe H.} and Maddison, {Emilie R.} and Henry, {Nathaniel J.} and Mumford, {John Everett} and Ryan Barber and Chloe Shields and Brown, {Jonathan C.} and Grant Nguyen and Austin Carter and Wolock, {Timothy M.} and Haidong Wang and Liu, {Patrick Y.} and Marissa Reitsma and Ross, {Jennifer M.} and Abajobir, {Amanuel Alemu} and Abate, {Kalkidan Hassen} and Kaja Abbas and Mubarek Abera and Abera, {Semaw Ferede} and Hareri, {Habtamu Abera} and Muktar Ahmed and Alene, {Kefyalew Addis} and Nelson Alvis-Guzman and Joshua Amo-Adjei and Jason Andrews and Hossein Ansari and Antonio, {Carl Abelardo} and Palwasha Anwari and Hamid Asayesh and Atey, {Tesfay Mehari} and Sachin Atre and Aleksandra Barac and Justin Beardsley and Neeraj Bedi and Isabela Bensenor and Beyene, {Addisu Shunu} and Butt, {Zahid Ahmad} and Cardona, {Pere Joan} and Christopher, {Devasahayam J.} and Lalit Dandona and Rakhi Dandona and Kebede Deribe and Amare Deribew and Rebecca Ehrenkranz and {El Sayed Zaki}, Maysaa and Aman Endries and Feyissa, {Tesfaye R.} and Florian Fischer and Ruoyan Gai and Seok-Jun Yoon",
year = "2018",
month = "3",
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doi = "10.1016/S1473-3099(17)30703-X",
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TY - JOUR

T1 - The global burden of tuberculosis

T2 - results from the Global Burden of Disease Study 2015

AU - GBD Tuberculosis Collaborators

AU - Kyu, Hmwe H.

AU - Maddison, Emilie R.

AU - Henry, Nathaniel J.

AU - Mumford, John Everett

AU - Barber, Ryan

AU - Shields, Chloe

AU - Brown, Jonathan C.

AU - Nguyen, Grant

AU - Carter, Austin

AU - Wolock, Timothy M.

AU - Wang, Haidong

AU - Liu, Patrick Y.

AU - Reitsma, Marissa

AU - Ross, Jennifer M.

AU - Abajobir, Amanuel Alemu

AU - Abate, Kalkidan Hassen

AU - Abbas, Kaja

AU - Abera, Mubarek

AU - Abera, Semaw Ferede

AU - Hareri, Habtamu Abera

AU - Ahmed, Muktar

AU - Alene, Kefyalew Addis

AU - Alvis-Guzman, Nelson

AU - Amo-Adjei, Joshua

AU - Andrews, Jason

AU - Ansari, Hossein

AU - Antonio, Carl Abelardo

AU - Anwari, Palwasha

AU - Asayesh, Hamid

AU - Atey, Tesfay Mehari

AU - Atre, Sachin

AU - Barac, Aleksandra

AU - Beardsley, Justin

AU - Bedi, Neeraj

AU - Bensenor, Isabela

AU - Beyene, Addisu Shunu

AU - Butt, Zahid Ahmad

AU - Cardona, Pere Joan

AU - Christopher, Devasahayam J.

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Deribe, Kebede

AU - Deribew, Amare

AU - Ehrenkranz, Rebecca

AU - El Sayed Zaki, Maysaa

AU - Endries, Aman

AU - Feyissa, Tesfaye R.

AU - Fischer, Florian

AU - Gai, Ruoyan

AU - Yoon, Seok-Jun

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. Methods: We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. Findings: Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (−4·1% [−5·0 to −3·4]) than in incidence (−1·6% [−1·9 to −1·2]) and prevalence (−0·7% [−1·0 to −0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3–13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8–14·8), and smoking accounted for 7·8% (3·8–12·0). Interpretation: Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis. Funding: Bill & Melinda Gates Foundation.

AB - Background: An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. Methods: We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. Findings: Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (−4·1% [−5·0 to −3·4]) than in incidence (−1·6% [−1·9 to −1·2]) and prevalence (−0·7% [−1·0 to −0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3–13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8–14·8), and smoking accounted for 7·8% (3·8–12·0). Interpretation: Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis. Funding: Bill & Melinda Gates Foundation.

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U2 - 10.1016/S1473-3099(17)30703-X

DO - 10.1016/S1473-3099(17)30703-X

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VL - 18

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EP - 284

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

SN - 1473-3099

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