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Global, Regional, and National Burden of Tuberculosis, 1990-2016: Results From the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study Publisher Pubmed



Kyu HH1, 2 ; Maddison ER2 ; Henry NJ2 ; Ledesma JR2 ; Wiens KE2 ; Biehl MH2 ; Shields C2 ; Osgoodzimmerman A2 ; Ross JM3 ; Carter A2 ; Frank TD2 ; Wang H1, 2 ; Srinivasan V2 ; Abebe Z12 Show All Authors
Authors
  1. Kyu HH1, 2
  2. Maddison ER2
  3. Henry NJ2
  4. Ledesma JR2
  5. Wiens KE2
  6. Biehl MH2
  7. Shields C2
  8. Osgoodzimmerman A2
  9. Ross JM3
  10. Carter A2
  11. Frank TD2
  12. Wang H1, 2
  13. Srinivasan V2
  14. Abebe Z12
  15. Agarwal SK5
  16. Alahdab F7, 8
  17. Alene KA9, 13, 14
  18. Ali BA15, 16
  19. Alvisguzman N17, 18, 19
  20. Andrews JR20
  21. Antonio CAT22, 23
  22. Atique S9, 25, 26
  23. Atre SR27, 29, 30
  24. Awasthi A31, 32
  25. Ayele HT33, 34
  26. Badali H35
  27. Badawi A39, 40, 41
  28. Barac A42, 43
  29. Bedi N44, 45
  30. Behzadifar M46, 47
  31. Behzadifar M46, 47
  32. Bekele BB9, 34
  33. Belay SA50
  34. Bensenor IM51
  35. Butt ZA52, 53
  36. Carvalho F9, 56
  37. Cercy K2
  38. Christopher DJ57, 58
  39. Daba AK59
  40. Dandona L2, 32
  41. Dandona R2, 32
  42. Daryani A36
  43. Demeke FM10
  44. Deribe K3, 60
  45. Dharmaratne SD2, 61
  46. Doku DT62, 63
  47. Dubey M64
  48. Edessa D65
  49. Elkhatib Z68
  50. Enany S69
  51. Fernandes E54
  52. Fischer F70
  53. Garciabasteiro AL71, 72
  54. Gebre AK65
  55. Gebregergs GB60
  56. Gebremichael TG65
  57. Gelano TF67
  58. Geremew D10
  59. Gona PN77, 78
  60. Goodridge A79
  61. Gupta R80, 81
  62. Bidgoli HH82
  63. Hailu GB73
  64. Hassen HY34, 83
  65. Hedayati MTT35, 38
  66. Henok A49
  67. Hostiuc S84
  68. Hussen MA85
  69. Ilesanmi OS86
  70. Irvani SSN87, 88
  71. Jacobsen KH95, 96
  72. Johnson SC2
  73. Jonas JB97, 98, 99
  74. Kahsay A74
  75. Kant S100
  76. Kasaeian A89, 93
  77. Kassa TD75
  78. Khader YS101
  79. Khafaie MA102
  80. Khalil I1, 2
  81. Khan EA11
  82. Khang YH81, 103
  83. Kim YJ76, 104
  84. Kochhar S3, 105
  85. Koyanagi A106
  86. Krohn KJ2
  87. Kumar GA32
  88. Lakew AM11
  89. Leshargie CT107
  90. Lodha R6
  91. Macarayan ERK24, 108
  92. Majdzadeh R90, 94
  93. Martinsmelo FR109
  94. Melese A110
  95. Memish ZA111, 112
  96. Mendoza W113
  97. Mengistu DT76
  98. Mengistu G65, 114
  99. Mestrovic T115, 116
  100. Moazen B9, 117
  101. Mohammad KA17, 118
  102. Mohammed S9, 119
  103. Mokdad AH1, 2
  104. Moosazadeh M37
  105. Mousavi SM91
  106. Mustafa G120, 121
  107. Nachega JB28
  108. Nguyen LH122
  109. Nguyen SH123
  110. Nguyen TH122
  111. Ningrum DNA124, 125, 126
  112. Nirayo YL75
  113. Nong VM127
  114. Oforiasenso R128, 129
  115. Ogbo FA130
  116. Oh IH131
  117. Oladimeji O132, 133
  118. Olagunju AT134, 135
  119. Oren E4, 136
  120. Pereira DM54, 137
  121. Prakash S5
  122. Qorbani M88
  123. Rafay A138
  124. Rai RK139, 140
  125. Ram U141
  126. Rubino S142
  127. Safiri S143
  128. Salomon JA21
  129. Samy AM144
  130. Sartorius B145
  131. Satpathy M146, 147
  132. Seyedmousavi S38, 92
  133. Sharif M148
  134. Silva JP55
  135. Silveira DGA149, 150
  136. Singh JA28, 151
  137. Sreeramareddy CT152, 153
  138. Tran BX154
  139. Tsadik AG65
  140. Ukwaja KN155
  141. Ullah I156, 157
  142. Uthman OA158
  143. Vlassov V159
  144. Vollset SE1, 2
  145. Vu G123
  146. Weldegebreal F66
  147. Werdecker A129, 160
  148. Yimer EM65
  149. Yonemoto N161
  150. Yotebieng M162, 163
  151. Naghavi M1, 2
  152. Vos T1, 2
  153. Hay SI1, 2
  154. Murray CJL1, 2
Show Affiliations
Authors Affiliations
  1. 1. Department of Health Metrics Sciences, United States
  2. 2. Institute for Health Metrics and Evaluation, Seattle, 98121, WA, United States
  3. 3. Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
  4. 4. University of Washington, Seattle, WA, United States
  5. 5. Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  6. 6. Department of Paediatrics, United States
  7. 7. All India Institute of Medical Sciences, New Delhi, India
  8. 8. Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, United States
  9. 9. University Institute of Public Health, University of Lahore, Lahore, Pakistan
  10. 10. Department of Medical Microbiology, United States
  11. 11. Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
  12. 12. Human Nutrition Department, United States
  13. 13. University of Gondar, Gondar, Ethiopia
  14. 14. Research School of Population Health, Australian National University, Canberra, ACT, Australia
  15. 15. Medical Technical Institute, Erbil Polytechnic University, Erbil, Iraq
  16. 16. Faculty of Pharmacy, United States
  17. 17. Ishik University, Erbil, Iraq
  18. 18. Research Group on Health Economics, University of Cartagena, Cartagena, Colombia
  19. 19. Research Group in Hospital Management and Health Policies, University of the Coast, Barranquilla, Colombia
  20. 20. Division of Infectious Disease and Geographic Medicine, United States
  21. 21. Center for Health Policy, Center for Primary Care and Outcomes Research, United States
  22. 22. Stanford University, Stanford, CA, United States
  23. 23. Department of Health Policy and Administration, United States
  24. 24. Development and Communication Studies, United States
  25. 25. University of the Philippines Manila, Manila, Philippines
  26. 26. University of Hail, Hail, Saudi Arabia
  27. 27. Center for Clinical Global Health Education, United States
  28. 28. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
  29. 29. Johns Hopkins University, Baltimore, MD, United States
  30. 30. Dr. D.y. Patil Medical College, Dr. D.y. Patil Vidyapeeth, Pune, India
  31. 31. Indian Institute of Public Health, Gandhinagar, India
  32. 32. Public Health Foundation of India, Gurugram, India
  33. 33. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
  34. 34. Public Health Department, Dilla University, Dilla, Ethiopia
  35. 35. Department of Medical Mycology, United States
  36. 36. Toxoplasmosis Research Center, United States
  37. 37. Health Sciences Research Center, United States
  38. 38. Invasive Fungi Research Center, United States
  39. 39. Mazandaran University of Medical Sciences, Sari, Iran
  40. 40. Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, ON, Canada
  41. 41. Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
  42. 42. Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
  43. 43. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  44. 44. Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
  45. 45. Jazan University, Jazan, Saudi Arabia
  46. 46. Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  47. 47. Social Determinants of Health Research Center, United States
  48. 48. Lorestan University of Medical Sciences, Khorramabad, Iran
  49. 49. Mizan-Tepi University, Teppi, Ethiopia
  50. 50. Dr. Tewelde Legesse Health Sciences College, Mekelle, Ethiopia
  51. 51. Department of Internal Medicine, University of Sao Paulo, Sao Paulo, Brazil
  52. 52. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
  53. 53. Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
  54. 54. REQUIMTE/LAQV, United States
  55. 55. Ucibio, United States
  56. 56. Applied Molecular Biosciences Unit, United States
  57. 57. University of Porto, Porto, Portugal
  58. 58. Department of Pulmonary Medicine, Christian Medical College and Hospital (CMC), Vellore, India
  59. 59. College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
  60. 60. School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
  61. 61. Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  62. 62. Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
  63. 63. Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
  64. 64. United Nations World Food Programme, New Delhi, India
  65. 65. School of Pharmacy, United States
  66. 66. Department of Medical Laboratory Science, United States
  67. 67. Haramaya University, Harar, Ethiopia
  68. 68. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  69. 69. Department of Microbiology and Immunology, Suez Canal University, Ismailia, Egypt
  70. 70. Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany
  71. 71. Tuberculosis, Manhica Health Research Center, Manhica, Mozambique
  72. 72. Tuberculosis Department, Barcelona Institute for Global Health, Barcelona, Spain
  73. 73. Biomedical Sciences Division, United States
  74. 74. Department of Nutrition and Dietetics, United States
  75. 75. Clinical Pharmacy Unit, United States
  76. 76. School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
  77. 77. Mekelle University, Mekelle, Ethiopia
  78. 78. Nursing and Health Sciences Department, University of Massachusetts Boston, Boston, MA, United States
  79. 79. Tuberculosis Biomarker Research Unit, Institute for Scientific Research and High Technology Services, City Of Knowledge, Panama
  80. 80. Commissioner of Public Health, West Virginia Bureau for Public Health, Charleston, WV, United States
  81. 81. Department of Health Policy, Management and Leadership, West Virginia University School of Public Health, Morgantown, WV, United States
  82. 82. Institute for Global Health, University College London, London, United Kingdom
  83. 83. Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
  84. 84. Faculty of Dentistry, Dept of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  85. 85. Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
  86. 86. Department of Public Health and Community Medicine, University of Liberia, Monrovia, Liberia
  87. 87. Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  88. 88. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  89. 89. Hematology-Oncology and Stem Cell Transplantation Research Center, United States
  90. 90. Community-Based Participatory-Research Center CBPR, United States
  91. 91. Department of Health Management and Economics, United States
  92. 92. Center of Expertise in Microbiology, United States
  93. 93. Hematologic Malignancies Research Center, United States
  94. 94. Knowledge Utilization Research Center, United States
  95. 95. Tehran University of Medical Sciences, Tehran, Iran
  96. 96. Department of Global and Community Health, George Mason University, Fairfax, VA, United States
  97. 97. Department of Ophthalmology, United States
  98. 98. Heidelberg University, Mannheim, Germany
  99. 99. Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
  100. 100. Department of Respiratory Medicine, King George's Medical University, Lucknow, India
  101. 101. Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
  102. 102. Department of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  103. 103. Institute of Health Policy and Management, United States
  104. 104. Seoul National University, Seoul, South Korea
  105. 105. Department of Public Health, Erasmus University Medical Center, Rotterham, Netherlands
  106. 106. Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi De Llobregat, Spain
  107. 107. Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
  108. 108. Ariadne Labs, Harvard University, Boston, MA, United States
  109. 109. Campus Caucaia, Federal Institute of Education, Science and Technology of Ceara, Caucaia, Brazil
  110. 110. College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
  111. 111. Research Department Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
  112. 112. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  113. 113. Peru Country Office, United Nations Population Fund, UNFPA, Lima, Peru
  114. 114. Department of Pharmacy, Wollo University, Dessie, Ethiopia
  115. 115. Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
  116. 116. University Centre Varazdin, University North, Varazdin, Croatia
  117. 117. Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
  118. 118. Department of Biology, Salahaddin University, Erbil, Iraq
  119. 119. Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
  120. 120. Pediatrics Department, Nishtar Medical University, Multan, Pakistan
  121. 121. Pediatrics and Pediatric Pulmonology, Institute of Mother and Child Care, Multan, Pakistan
  122. 122. Center for Excellence in Behavioral Health, United States
  123. 123. Center of Excellence in Behavioral Medicine, United States
  124. 124. Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
  125. 125. Public Health Science Department, State University of Semarang, Kota Semarang, Indonesia
  126. 126. Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
  127. 127. Institute for Global Health Innovations, Duy Tan University, Hanoi, Viet Nam
  128. 128. Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia
  129. 129. Independent Consultant, Accra, Ghana
  130. 130. Western Sydney University, Penrith, NSW, Australia
  131. 131. Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
  132. 132. Human Sciences Research Council, Durban, South Africa
  133. 133. School of Public Health, Faculty of Health Sciences, University of Namibia, Osakhati, Namibia
  134. 134. University of Adelaide, Adelaide, SA, Australia
  135. 135. Department of Psychiatry, University of Lagos, Lagos, Nigeria
  136. 136. Graduate School of Public Health, San Diego State University, San Diego, CA, United States
  137. 137. Cartagena University, Cartagena, Colombia
  138. 138. Department of Epidemiology and Biostatistics, Contech School of Public Health, Lahore, Pakistan
  139. 139. Society for Health and Demographic Surveillance, Suri, India
  140. 140. Department of Economics, University of Goettingen, Gottingen, Germany
  141. 141. Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
  142. 142. Department of Biomedical Science, University of Sassari, Sassari, Italy
  143. 143. Managerial Epidemiology Research Center, Maragheh University of Medical Sciences, Maragheh, Iran
  144. 144. Department of Entomology, Ain Shams University, Cairo, Egypt
  145. 145. Department of Public Health Medicine, University of Kwazulu-natal, Durban, South Africa
  146. 146. Ugc Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
  147. 147. Udyam-global Association for Sustainable Development, Bhubaneswar, India
  148. 148. Department of Basic Sciences, Islamic Azad University, Sari, Iran
  149. 149. Brasilia University, Brasilia, Brazil
  150. 150. Department of the Health Industrial Complex and Innovation in Health, Federal Ministry of Health, Brasilia, Brazil
  151. 151. Department of Medicine, United States
  152. 152. University of Alabama at Birmingham, Birmingham, AL, United States
  153. 153. Division of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
  154. 154. Department of Health Economics, Hanoi Medical University, Hanoi, Viet Nam
  155. 155. Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
  156. 156. Gomal University, Dera Ismail Khan, Pakistan
  157. 157. Tb Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
  158. 158. Division of Health Sciences, University of Warwick, Coventry, United Kingdom
  159. 159. Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russian Federation
  160. 160. Demographic Change and Ageing Research Area, Federal Institute for Population Research, Wiesbaden, Germany
  161. 161. Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
  162. 162. College of Public Health, Ohio State University, Columbus, OH, United States
  163. 163. School of Public Health, University of Kinshasa, Kinshasa, Congo

Source: The Lancet Infectious Diseases Published:2018


Abstract

Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis 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 the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05-10·16) and the number of tuberculosis deaths was 1·21 million (1·16-1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01-1·89) and the number of tuberculosis deaths was 0·24 million (0·16-0·31). Globally, among HIV-negative individuals the agestandardised incidence of tuberculosis decreased annually at a slower rate (-1·3% [-1·5 to -1·2]) than mortality did (-4·5% [-5·0 to -4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was -4·0% (-4·5 to -3·7) and mortality was -8·9% (-9·5 to -8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV. Funding Bill & Melinda Gates Foundation. © 2018 The Author(s).
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