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Tuberculosis: generation effects and chemotherapy.

R G Stevens, J A Lee

    American Journal of Epidemiology
    |February 1, 1978
    PubMed
    Summary
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    Generation-based models inaccurately predict tuberculosis mortality. Effective chemotherapy altered outcomes, leading to significant deviations from predictions, especially after the 1950s.

    Area of Science:

    • Epidemiology
    • Public Health
    • Medical History

    Background:

    • Pulmonary tuberculosis mortality analysis is crucial for public health planning.
    • Traditional generation-based models for disease mortality may become outdated with medical advancements.
    • Effective chemotherapy for tuberculosis emerged, potentially altering historical mortality trends.

    Purpose of the Study:

    • To analyze mortality from pulmonary tuberculosis in the United States by cohort.
    • To evaluate the appropriateness of generation-based models in light of chemotherapy's impact.
    • To assess the accuracy of mortality projections using generation models.

    Main Methods:

    • Cohort analysis of US pulmonary tuberculosis mortality data.
    • Comparison of observed mortality with predictions from a generation-based model.

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  • Analysis of racial differences in mortality trends.

    • Main Results:

    • Generation-based models showed significant departures from actual mortality data starting in the 1950s.
    • A generation model projected 358,000 excess deaths by 1970 compared to actual figures.
    • Observed deviations were smaller for Black populations than White populations, suggesting treatment delivery differences.

    Conclusions:

    • Generation-based models are inadequate for predicting tuberculosis mortality post-chemotherapy introduction.
    • Mortality projections require accounting for dynamic changes in disease progression and treatment efficacy.
    • Inter-cohort differences in mortality can be modified by interventions during adult life.