Global, regional, and national estimates of tuberculosis incidence and case detection among incarcerated individuals from 2000 to 2019: a systematic analysis

Abstract

Background: People who are incarcerated are at high risk of developing tuberculosis. We aimed to estimate the annual global, regional, and national incidence of tuberculosis among incarcerated populations from 2000 to 2019.

Methods: We collected and aggregated data for tuberculosis incidence and prevalence estimates among incarcerated individuals in published and unpublished literature, annual tuberculosis notifications among incarcerated individuals at the country level, and the annual number of incarcerated individuals at the country level. We developed a joint hierarchical Bayesian meta-regression framework to simultaneously model tuberculosis incidence, notifications, and prevalence from 2000 to 2019. Using this model, we estimated trends in absolute tuberculosis incidence and notifications, the incidence and notification rates, and the case detection ratio by year, country, region, and globally.

Findings: In 2019, we estimated a total of 125 105 (95% credible interval [CrI] 93 736-165 318) incident tuberculosis cases among incarcerated individuals globally. The estimated incidence rate per 100 000 person-years overall was 1148 (95% CrI 860-1517) but varied greatly by WHO region, from 793 (95% CrI 430-1342) in the Eastern Mediterranean region to 2242 (1515-3216) in the African region. Global incidence per 100 000 person-years between 2000 and 2012 among incarcerated individuals decreased from 1884 (95% CrI 1394-2616) to 1205 (910-1615); however, from 2013 onwards, tuberculosis incidence per 100 000 person-years was stable, from 1183 (95% CrI 876-1596) in 2013 to 1148 (860-1517) in 2019. In 2019, the global case detection ratio was estimated to be 53% (95% CrI 42-64), the lowest over the study period.

Interpretation: Our estimates suggest a high tuberculosis incidence rate among incarcerated individuals globally with large gaps in tuberculosis case detection. Tuberculosis in incarcerated populations must be addressed with interventions specifically tailored to improve diagnoses and prevent transmission as a part of the broader global tuberculosis control effort.

Funding: National Institutes of Health.

Figure 1

Flowchart of data collection and analysis Collection for each data type, statistical model structure, and connections between models is further described in the Article and appendix (pp 5–8). Seven countries were excluded from the analysis because of no tuberculosis or incarceration data: North Korea, Eritrea, occupied Palestinian territory, Serbia, Montenegro, Somalia, and Niue. Countries include all WHO member countries in addition to several territories either not recognised by WHO or not officially designated as a country. A full list of all countries with data can be found in the appendix (pp 13–16) as well as the countries not included. MOH=ministries of health. NTPs=national tuberculosis programmes.

Figure 2

Estimated tuberculosis incidence in prisons (cases per 100 000 person-years) by country in 2019

Figure 3

Estimated new tuberculosis cases and notifications among incarcerated individuals in 2019 for countries with the highest number of incarcerated people Error bars show the 95% highest posterior density credible intervals for incidence estimates. Estimated numbers are posterior medians.

Figure 4

Trends in tuberculosis incidence estimates among incarcerated individuals compared with the general population for each WHO region from 2000 to 2019 The solid red line is modelled estimates (posterior medians) and the shaded bands are 95% highest posterior density credible intervals for tuberculosis cases in each WHO region. Blue lines represent tuberculosis incidence in the general population.

Figure 5

Trends in the absolute number of tuberculosis cases among incarcerated individuals for each WHO region from 2000 to 2019 The solid red line is modelled estimates (posterior medians) and the shaded bands are 95% highest posterior density credible intervals for tuberculosis cases in each WHO region.