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.

Rifampicin-resistant tuberculosis (RR-TB) requires longer, more toxic therapy than rifampicin-sensitive disease and is associated with a higher occurrence of long-term sequelae. In this mathematical modeling study, the authors estimate that incident RR-TB in 2020 will be responsible for ~6.9 million disability-adjusted life years; 44% due to post-tuberculosis sequelae.

Details

Title
Global burden of disease due to rifampicin-resistant tuberculosis: a mathematical modeling analysis
Author
Menzies, Nicolas A. 1   VIAFID ORCID Logo  ; Allwood, Brian W. 2 ; Dean, Anna S. 3   VIAFID ORCID Logo  ; Dodd, Pete J. 4   VIAFID ORCID Logo  ; Houben, Rein M. G. J. 5 ; James, Lyndon P. 6 ; Knight, Gwenan M. 7   VIAFID ORCID Logo  ; Meghji, Jamilah 8 ; Nguyen, Linh N. 3 ; Rachow, Andrea 9 ; Schumacher, Samuel G. 3 ; Mirzayev, Fuad 3   VIAFID ORCID Logo  ; Cohen, Ted 10   VIAFID ORCID Logo 

 Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X); Harvard T. H. Chan School of Public Health, Center for Health Decision Science, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X) 
 Stellenbosch University & Tygerberg Hospital, Division of Pulmonology, Department of Medicine, Cape Town, South Africa (GRID:grid.11956.3a) (ISNI:0000 0001 2214 904X) 
 World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland (GRID:grid.3575.4) (ISNI:0000 0001 2163 3745) 
 University of Sheffield, School of Health and Related Research, Sheffield, United Kingdom (GRID:grid.11835.3e) (ISNI:0000 0004 1936 9262) 
 London School of Hygiene and Tropical Medicine, TB Modelling Group, TB Centre, London, United Kingdom (GRID:grid.8991.9) (ISNI:0000 0004 0425 469X); London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom (GRID:grid.8991.9) (ISNI:0000 0004 0425 469X) 
 Harvard T. H. Chan School of Public Health, Center for Health Decision Science, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X); Harvard University, Harvard Interfaculty Initiative in Health Policy, Cambridge, USA (GRID:grid.38142.3c) (ISNI:0000 0004 1936 754X) 
 EPH, London School of Hygiene and Tropical Medicine, AMR Centre, Department of Infectious Disease Epidemiology, London, United Kingdom (GRID:grid.8991.9) (ISNI:0000 0004 0425 469X) 
 Imperial College London, National Heart & Lung Institute, London, United Kingdom (GRID:grid.7445.2) (ISNI:0000 0001 2113 8111) 
 Medical Centre of the University of Munich (LMU), Division of Infectious Diseases and Tropical Medicine, Munich, Germany (GRID:grid.5252.0) (ISNI:0000 0004 1936 973X); Partner Site Munich, German Centre for Infection Research (DZIF), Munich, Germany (GRID:grid.452463.2); German Research Center for Environmental Health (HMGU), Unit Global Health, Helmholtz Zentrum München, Neuherberg, Germany (GRID:grid.4567.0) (ISNI:0000 0004 0483 2525) 
10  Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710) 
Pages
6182
Publication year
2023
Publication date
2023
Publisher
Nature Publishing Group
e-ISSN
20411723
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2872534804
Copyright
© The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.