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Tomeny, Ewan 
ORCID: https://orcid.org/0000-0003-4547-2389, Nightingale, Rebecca, Chinoko, Beatrice, Nikolaidis, Georgios, Madan, Jason, Worrall, Eve ORCID: https://orcid.org/0000-0001-9147-3388, Ngwira, Lucky-Gift, Banda, Ndaziona, Lönnroth, Knut, Evans, Denise, Muhwa, Jeremiah, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Mortimer, Kevin ORCID: https://orcid.org/0000-0002-8118-8871, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 and Meghji, Jamilah ORCID: https://orcid.org/0000-0002-4693-8884
(2022)
'TB morbidity estimates overlook the contribution of post-TB disability : evidence from urban Malawi'. BMJ Global Health, Vol 7, Issue 5, e007643.
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Abstract
Introduction
Despite growing evidence of the long-term impact of tuberculosis (TB) on quality of life, Global Burden of Disease (GBD) estimates of TB-related disability-adjusted life-years (DALYs) do not include post-TB morbidity, and evaluations of TB interventions typically assume treated patients return to pre-TB health. Using primary data, we estimate years of life lost due to disability (YLDs), years of life lost due to premature mortality (YLL), and DALYs associated with post-TB cardio-respiratory morbidity in a low-income country.
Methods
Adults ≥15-years who had successfully completed treatment for drug-sensitive pulmonary tuberculosis in Blantyre, Malawi (February 2016–March 2020) were followed-up for three-years with 6- and 12-
monthly study visits. In this secondary analysis, St George’s Respiratory Questionnaire data were used to match patients to GBD cardio-respiratory health states and corresponding disability weights (DWs) at each visit. YLDs were calculated for the study period and estimated for remaining lifespan using Malawian life-table life expectancies. Years of life lost due to premature mortality (YLL) were estimated using study mortality data and aspirational life expectancies, and post-TB DALYs derived. Data were disaggregated by HIV-status and gender.
Results
At treatment completion 222/403(55·1%) participants met criteria for a cardio-respiratory DW, decreasing to 15·6% after three-years, at which point two-thirds of the disability burden was experienced by women. Over 90% of projected lifetime-YLD were concentrated within the most severely affected 20% of survivors. Mean DWs in the three-years post-treatment were 0·041(HIV-) and 0·025(HIV+), and beyond three-years estimated as 0·025(HIV-) and 0·010(HIV+), compared to GBD DWs of 0·408(HIV+) and 0·333(HIV-) during active disease. Our results imply that the majority of TB-related morbidity occurs post-treatment.
Conclusion
TB-related DALYs are greatly underestimated by overlooking post-TB disability. The total disability-burden of tuberculosis is likely undervalued by both GBD estimates and economic evaluations of
interventions, particularly those aimed at early diagnosis and prevention.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > WA 30 Socioeconomic factors in public health (General) WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 205 Epidemiology WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis WF Respiratory System > Tuberculosis > WF 315 Diet. Rest. Exercise. Home care |
| Faculty: Department: | Biological Sciences > Vector Biology Department Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1136/bmjgh-2021-007643 |
| Depositing User: | Mary Creegan |
| Date Deposited: | 26 May 2022 11:31 |
| Last Modified: | 29 Jun 2022 12:40 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/20333 |
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