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. 2023 Oct 4;14(1):6182.
doi: 10.1038/s41467-023-41937-9.

Global burden of disease due to rifampicin-resistant tuberculosis: a mathematical modeling analysis

Nicolas A Menzies  1   2 , Brian W Allwood #  3 , Anna S Dean #  4 , Pete J Dodd #  5 , Rein M G J Houben #  6   7 , Lyndon P James #  8   9 , Gwenan M Knight #  10 , Jamilah Meghji #  11 , Linh N Nguyen #  4 , Andrea Rachow #  12   13   14 , Samuel G Schumacher #  4 , Fuad Mirzayev  4 , Ted Cohen  15
Affiliations

Global burden of disease due to rifampicin-resistant tuberculosis: a mathematical modeling analysis

Nicolas A Menzies et al. Nat Commun. .

Abstract

In 2020, almost half a million individuals developed rifampicin-resistant tuberculosis (RR-TB). We estimated the global burden of RR-TB over the lifetime of affected individuals. We synthesized data on incidence, case detection, and treatment outcomes in 192 countries (99.99% of global tuberculosis). Using a mathematical model, we projected disability-adjusted life years (DALYs) over the lifetime for individuals developing tuberculosis in 2020 stratified by country, age, sex, HIV, and rifampicin resistance. Here we show that incident RR-TB in 2020 was responsible for an estimated 6.9 (95% uncertainty interval: 5.5, 8.5) million DALYs, 44% (31, 54) of which accrued among TB survivors. We estimated an average of 17 (14, 21) DALYs per person developing RR-TB, 34% (12, 56) greater than for rifampicin-susceptible tuberculosis. RR-TB burden per 100,000 was highest in former Soviet Union countries and southern African countries. While RR-TB causes substantial short-term morbidity and mortality, nearly half of the overall disease burden of RR-TB accrues among tuberculosis survivors. The substantial long-term health impacts among those surviving RR-TB disease suggest the need for improved post-treatment care and further justify increased health expenditures to prevent RR-TB transmission.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Average DALYs per RR-TB case from increased disability and mortality rates attributable to tuberculosis, stratified by tuberculosis disease and post-tuberculosis period.
Area of each green and blue rectangle and shaded regions are proportional to the number of DALYs indicated, other dimensions not to scale. Values in parentheses represent 95% uncertainty intervals. Total RR-TB DALYs per incident tuberculosis case are equal to the sum of these values. DALYs disability-adjusted life years, RR-TB rifampicin-resistant tuberculosis, RS-TB rifampicin-susceptible tuberculosis.
Fig. 2
Fig. 2. Estimated DALYs per 100,000 due to incident RR-TB in 2020 by country.
DALYs disability-adjusted life years, RR-TB rifampicin-resistant tuberculosis.
Fig. 3
Fig. 3. Estimated DALYs per incident case due to incident RR-TB in 2020 by country.
DALYs disability-adjusted life years, RR-TB rifampicin-resistant tuberculosis.
Fig. 4
Fig. 4. Schematic of study inputs and estimation process.
DALYs disability-adjusted life years, RR-TB rifampicin-resistant tuberculosis, RS-TB rifampicin-susceptible tuberculosis.
See this image and copyright information in PMC

References

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