Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020–2021
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Published:2023-08-30
Issue:9
Volume:11
Page:2191
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ISSN:2076-2607
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Container-title:Microorganisms
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language:en
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Short-container-title:Microorganisms
Author:
Ledesma Jorge R.12, Basting Ann1ORCID, Chu Huong T.13, Ma Jianing4, Zhang Meixin1, Vongpradith Avina1, Novotney Amanda1, Dalos Jeremy1, Zheng Peng13, Murray Christopher J. L.13, Kyu Hmwe H.13
Affiliation:
1. Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA 2. Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02912, USA 3. Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA 4. Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, 1800 Cannon Drive, Columbus, OH 43210, USA
Abstract
Evaluating cross-country variability on the impact of the COVID-19 pandemic on tuberculosis (TB) may provide urgent inputs to control programs as countries recover from the pandemic. We compared expected TB notifications, modeled using trends in annual TB notifications from 2013–2019, with observed TB notifications to compute the observed to expected (OE) ratios for 170 countries. We applied the least absolute shrinkage and selection operator (LASSO) method to identify the covariates, out of 27 pandemic- and tuberculosis-relevant variables, that had the strongest explanatory power for log OE ratios. The COVID-19 pandemic was associated with a 1.55 million (95% CI: 1.26–1.85, 21.0% [17.5–24.6%]) decrease in TB diagnoses in 2020 and a 1.28 million (0.90–1.76, 16.6% [12.1–21.2%]) decrease in 2021 at a global level. India, Indonesia, the Philippines, and China contributed the most to the global declines for both years, while sub-Saharan Africa achieved pre-pandemic levels by 2021 (OE ratio = 1.02 [0.99–1.05]). Age-stratified analyses revealed that the ≥ 65-year-old age group experienced greater relative declines in TB diagnoses compared with the under 65-year-old age group in 2020 (RR = 0.88 [0.81–0.96]) and 2021 (RR = 0.88 [0.79–0.98]) globally. Covariates found to be associated with all-age OE ratios in 2020 were age-standardized smoking prevalence in 2019 (β = 0.973 [0.957–990]), school closures (β = 0.988 [0.977–0.998]), stay-at-home orders (β = 0.993 [0.985–1.00]), SARS-CoV-2 infection rate (β = 0.991 [0.987–0.996]), and proportion of population ≥65 years (β = 0.971 [0.944–0.999]). Further research is needed to clarify the extent to which the observed declines in TB diagnoses were attributable to disruptions in health services, decreases in TB transmission, and COVID-19 mortality among TB patients.
Funder
Bill & Melinda Gates Foundation
Subject
Virology,Microbiology (medical),Microbiology
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