Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990-2019: results from the Global Burden of Disease Study 2019.
Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990-2019: results from the Global Burden of Disease Study 2019.
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1990 - 2019年，全球性结核病负担的全球，区域和国家性别差异：2019年全球疾病负担研究的结果。
DOI：
10.1016/s1473-3099(21)00449-7
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
GBD 2019 Tuberculosis Collaborators
中科院分区：
文献类型：
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作者：
GBD 2019 Tuberculosis Collaborators
结核病是造成全球疾病负担的主要因素，每年造成100多万人死亡。鉴于全球卫生目标强调结核病诊断和治疗机会的公平，评估按性别划分的结核病负担差异至关重要。我们的目标是评估全球结核病负担的水平和趋势，重点是调查从1990年到2019年204个国家和地区按艾滋病毒状况划分的性别差异。我们使用贝叶斯分层死因集成模型(CODEM)平台分析了21个 505个现场年的生命登记数据、705个现场年的口头尸检数据、825个基于样本的现场年的生命登记数据和680个现场年的死亡监测数据，以估计艾滋病毒阴性者中结核病的死亡率。我们使用人口归因分数方法来估计与艾滋病毒和结核病合并感染相关的死亡率。然后使用分区Meta回归工具(DisMod-MR 2.1)综合所有可用的数据源，包括患病率调查、年度病例通知、基于人群的结核病调查和结核病原因特定死亡率，以产生内部一致的发病率、流行率和死亡率的估计。我们进一步估计了在HIV阴性个体中，可归因于包括吸烟、饮酒和糖尿病在内的危险因素的独立影响的结核病死亡率。对于艾滋病毒和结核病合并感染的个人，我们评估了可归因于艾滋病毒风险因素的死亡率，包括不安全的性行为、亲密伴侣暴力(仅估计在女性中)和注射毒品使用。我们给出了所有估计的95%的不确定性区间。在全球范围内，2019年，在艾滋病毒阴性的个人中，有11800万人(95%不确定区间1·08-1·29)死于结核病，850万(7.45-9.73)例结核病病例。在艾滋病毒阳性个人中，2019年有217 000(153 000-279 000)死于结核病，115万(1·01-1·32)病例发生。2019年全球艾滋病毒阴性个体中男性的死亡和发病病例多于女性，其中男性死亡人数比女性多342 000(234 000-425 000)，男性发病病例比女性多101万(082-1·23)。在艾滋病毒阳性个人中，2019年女性比男性多发生6 250例(1820-11 400)死亡病例和81例 100(63 300-100 000)病例。2019年，105个国家艾滋病毒阴性男性的年龄标化死亡率是艾滋病毒阴性女性的两倍多，74个国家的年龄标化发病率是艾滋病毒阴性女性的1.5倍以上。2019年，全球因饮酒、吸烟和糖尿病而死亡的HIV阴性患者中，男性的比例分别是女性的4.27(3.69-5.02)、6.17(5.48-7.02)和1.17(1.07-1.28)倍。在HIV和结核病混合感染者中，男性因注射毒品死亡的比例是女性的2.23(2.03-2.44)倍，而不安全性行为的死亡率女性是男性的1.06(1.05-1.08)倍。随着各国完善国家结核病规划和战略以结束结核病流行，男性经历的过度负担是重要的。需要采取干预措施，积极向人们，特别是向男性宣传早期诊断和治疗的重要性。这些干预措施应与尽量减少艾滋病毒负担最高国家妇女的艾滋病毒负担的努力同时进行，因为艾滋病毒负担最高的国家是造成妇女艾滋病毒和结核病共同感染负担过度的国家。将重点放在艾滋病毒阴性男性中的结核病负担和女性中艾滋病毒和结核病的混合感染上，可能有助于减轻结核病的总体负担。这一战略对于实现全球卫生里程碑概述的公平和负担目标至关重要。比尔和梅琳达·盖茨基金会。
Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. Globally, in 2019, among HIV-negative individuals, there were 1·18 million (95% uncertainty interval 1·08–1·29) deaths due to tuberculosis and 8·50 million (7·45–9·73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000–279 000) deaths due to tuberculosis and 1·15 million (1·01–1·32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000–425 000) more deaths and 1·01 million (0·82–1·23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820–11 400) more deaths and 81 100 (63 300–100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1·5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4·27 (3·69–5·02), 6·17 (5·48–7·02), and 1·17 (1·07–1·28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2·23 (2·03–2·44) times greater among males than females, whereas the fraction due to unsafe sex was 1·06 (1·05–1·08) times greater among females than males. As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestones. Bill & Melinda Gates Foundation.