Quantifying the global number of tuberculosis survivors: a modelling study

Area of Science:

• Epidemiology
• Global Health
• Public Health

Background:

• Tuberculosis survivors experience significant clinical and societal challenges post-recovery.
• These challenges include increased risk of recurrent tuberculosis, premature mortality, diminished lung function, and persistent social stigma.

Purpose of the Study:

• To estimate the global number of individuals who developed tuberculosis between 1980 and 2019.
• To determine the number of these individuals alive in 2020.
• To quantify recent treatment uptake among tuberculosis survivors.

Main Methods:

• A modeling study utilizing country-level World Health Organization (WHO) tuberculosis case notifications and incidence data.
• Estimation of survival for treated and untreated tuberculosis cases using published age- and HIV-stratified case fatality ratios.
• Development of post-tuberculosis life tables incorporating UN mortality rates and hazard ratios to project survival over time.

Main Results:

• An estimated 363 million people developed tuberculosis from 1980-2019, with 172 million receiving treatment.
• By 2020, approximately 155 million tuberculosis survivors were alive, with the largest proportion in the WHO South-East Asia region.
• Among survivors alive in 2020, 18% received treatment in the past 5 years and 8% in the past 2 years.

Conclusions:

• The number of tuberculosis survivors significantly exceeds annual incidence, highlighting a substantial long-term population.
• Urgent prioritization of interventions is needed for recently treated tuberculosis survivors to address respiratory morbidity, prevent recurrence, and reduce stigma.