Burden of Chronic Obstructive Pulmonary Disease Attributable to Tuberculosis: A Microsimulation Study

Abstract

Tuberculosis (TB) is a risk factor for chronic obstructive pulmonary disease (COPD), but COPD is also a predictor of TB. The excess life-years lost to COPD caused by TB can potentially be saved by screening for and treating TB infection. We examined the number of life-years that could be saved by preventing TB and TB-attributable COPD. We compared the observed (no intervention) and counterfactual microsimulation models constructed from observed rates in the Danish National Patient Registry (covering all Danish hospitals between 1995 and 2014). In the Danish population of TB and COPD-naive individuals (n = 5,206,922), 27,783 persons (0.5%) developed TB. Among those who developed TB, 14,438 (52.0%) developed TB with COPD. Preventing TB saved 186,469 life-years overall. The excess number of life-years lost to TB alone was 7.07 years per person, and the additional number of life-years lost among persons who developed COPD after TB was 4.86 years per person. The life-years lost to TB-associated COPD are substantial, even in regions where TB can be expected to be identified and treated promptly. Prevention of TB could prevent a substantial amount of COPD-related morbidity; the benefit of screening and treatment for TB infection is underestimated by considering morbidity from TB alone.

Keywords: Danish National Patient Registry; chronic obstructive pulmonary disease; microsimulation; tuberculosis; tuberculosis prevention.

Figure 1

Intervention scenarios and incident disease pathways during a 100-year–period simulation, Denmark, 1995–2014. A) Individuals who started the study with no chronic obstructive pulmonary disease (COPD) and no tuberculosis (TB) at baseline (n = 5,206,922); B) individuals who started the study with COPD and no prior TB at baseline (n = 110,663).