Burden of Chronic Obstructive Pulmonary Disease Attributable to Tuberculosis: A Microsimulation Study

Area of Science:

• Pulmonary Medicine
• Epidemiology
• Public Health

Background:

• Tuberculosis (TB) is a known risk factor for chronic obstructive pulmonary disease (COPD).
• COPD also predicts the development of TB, indicating a complex bidirectional relationship.
• The impact of TB on life-years lost, particularly when associated with COPD, requires thorough investigation.

Purpose of the Study:

• To quantify the life-years saved by preventing TB and TB-attributable COPD.
• To compare observed outcomes with counterfactual scenarios using microsimulation models.
• To highlight the underestimated benefits of TB screening and treatment.

Main Methods:

• Microsimulation modeling comparing observed and counterfactual scenarios.
• Utilized data from the Danish National Patient Registry (1995-2014).
• Analyzed a population of 5,206,922 individuals initially naive to TB and COPD.

Main Results:

• 0.5% (27,783 individuals) developed TB in the study population.
• 52.0% (14,438 individuals) of those with TB also developed COPD.
• Preventing TB saved an estimated 186,469 life-years overall, with an additional 4.86 years per person saved by preventing TB-associated COPD.

Conclusions:

• TB-associated COPD leads to substantial life-years lost, even in settings with prompt TB diagnosis and treatment.
• Preventing TB can significantly reduce COPD-related morbidity.
• The benefits of TB screening and treatment are underestimated when COPD-related morbidity is not considered.