COVID-19 case fatality rate and tuberculosis in a metropolitan setting

Area of Science:

• Epidemiology
• Infectious Disease Research
• Public Health

Background:

• Tuberculosis (TB) is a significant public health issue in many endemic areas.
• The COVID-19 pandemic presented unique challenges, particularly in regions with pre-existing disease burdens.
• Understanding co-infection impacts and disease interactions is crucial for effective public health strategies.

Purpose of the Study:

• To investigate the association between tuberculosis (TB) case rates and COVID-19 case fatality rates (CFR) in districts of Lima, Peru.
• To determine if this association remains significant after adjusting for demographic and clinical confounders.

Main Methods:

• Ecological study design using 43 districts in Lima, Peru as units of observation.
• Linear regression analysis to assess the relationship between mean COVID-19 CFR (Weeks 5-32) and mean TB case rates (2017-2019).
• Adjusted for population density, socioeconomic status, housing conditions, healthcare access, and comorbidities (hypertension, diabetes, HIV).

Main Results:

• The average COVID-19 CFR in Lima was 4.0% ± 1.1%, with a mean TB rate of 16.0 cases per 10,000 population.
• A statistically significant association was found between higher TB case rates and increased COVID-19 CFR (β = 1.26; p=0.02).
• This association was independent of adjusted socioeconomic and comorbidity variables.

Conclusions:

• Districts in Lima with a higher burden of tuberculosis demonstrated elevated COVID-19 case fatality rates.
• The findings suggest a potential independent link between tuberculosis prevalence and COVID-19 mortality.
• Public health interventions should consider the impact of co-existing endemic diseases like TB on pandemic outcomes.