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TB morbidity estimates overlook the contribution of post-TB disability : evidence from urban Malawi

Tomeny, Ewan ORCID:, Nightingale, Rebecca, Chinoko, Beatrice, Nikolaidis, Georgios, Madan, Jason, Worrall, Eve ORCID:, Ngwira, Lucky-Gift, Banda, Ndaziona, Lönnroth, Knut, Evans, Denise, Muhwa, Jeremiah, Rylance, Jamie ORCID:, Mortimer, Kevin ORCID:, Squire, Bertie ORCID: and Meghji, Jamilah ORCID: (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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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.

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.

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.

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):
Depositing User: Mary Creegan
Date Deposited: 26 May 2022 11:31
Last Modified: 29 Jun 2022 12:40


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