The asymptomatic tuberculosis proportion among the elderly population: a systematic review and meta-analysis

Area of Science:

• Gerontology
• Infectious Diseases
• Public Health

Background:

• Elderly individuals are a vulnerable population for tuberculosis (TB).
• A significant proportion of TB cases in the elderly are asymptomatic.
• Active case finding is crucial for identifying TB in this demographic.

Purpose of the Study:

• To determine the prevalence of asymptomatic tuberculosis among elderly patients with active TB.
• To analyze factors influencing the proportion of asymptomatic TB in the elderly population.

Main Methods:

• Systematic literature search of multiple databases up to December 2023.
• Quality assessment of included studies using Agency for Healthcare Research and Quality criteria.
• Meta-analysis with heterogeneity assessment (I² statistic, Q test), subgroup analysis, sensitivity analysis, meta-regression, and publication bias tests (Begg's, Egger's).

Main Results:

• Nine studies including 364,260 elderly individuals were analyzed.
• The overall proportion of asymptomatic tuberculosis in the elderly was 67.7% (95% CI: 54.7-79.5%).
• Asymptomatic TB proportion was higher in high-burden countries (66.3%) and with multiple screening strategies (67.6%); it decreased in studies post-2019 (54.3%) and with large sample sizes (62.3%).

Conclusions:

• A high percentage of elderly individuals present with asymptomatic tuberculosis.
• Mass screening is essential for detecting active TB cases in the elderly.
• Findings can inform public health policies to reduce the TB burden in older adults.