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Explaining age disparities in tuberculosis burden in Taiwan: a modelling study
Han Fu1, Hsien-Ho Lin2, Timothy B Hallett3
1MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, W2 1PG, UK. h.fu15@imperial.ac.uk.
BMC Infectious Diseases
|March 6, 2020
Summary
Tuberculosis (TB) disproportionately affects older adults due to immune senescence and social mixing patterns. Understanding these factors is key for TB control, focusing on preventing active disease in latent cases rather than just transmission blocking.
Area of Science:
- Epidemiology
- Mathematical modeling
- Public health
Background:
- Tuberculosis (TB) incidence varies significantly by age, with older populations experiencing a much higher burden.
- In Taiwan, the TB notification rate for individuals over 65 was approximately 100 times higher than for those under 15 in 2016.
- The underlying reasons for these age-related disparities in TB burden remain unclear, necessitating further investigation for effective control strategies.
Purpose of the Study:
- To investigate the mechanisms driving age disparities in tuberculosis burden.
- To model the contributions of immune senescence, declining transmission, and assortative mixing to TB incidence across different age groups.
- To inform TB control strategies by identifying the most influential factors in specific settings.
Main Methods:
- Development of dynamic compartmental models incorporating three hypothesized mechanisms: immune senescence, past TB infection acquisition, and age-based social mixing (assortative mixing).
- Calibration of models using TB notification data from Taiwan (1997-2016).
- Evaluation of model fit to observed age disparities and temporal trends using goodness-of-fit metrics and the Deviance Information Criterion (DIC).
Main Results:
- A comprehensive model including all three mechanisms best explained the observed age disparities and temporal trends in TB notification rates.
- Immune senescence and assortative mixing were identified as the primary drivers of age-based TB burden differences.
- Declining TB transmission primarily accounted for the observed decrease in overall TB notification rates over time.
Conclusions:
- In intermediate TB burden settings like Taiwan, TB control efforts for the elderly should prioritize preventing the progression from latent infection to active disease.
- Case-finding strategies aimed at blocking transmission may be less impactful for reducing the current TB burden in older populations.
- Further research is needed to precisely quantify the impact of each mechanism and refine targeted TB control interventions.
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