The global burden of tuberculosis mortality in children: a mathematical modelling study.
The global burden of tuberculosis mortality in children: a mathematical modelling study.
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DOI：
10.1016/s2214-109x(17)30289-9
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发表时间：
2017-09
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影响因子：
--
通讯作者：
Jenkins HE
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文献类型：
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作者：
Dodd PJ;Yuen CM;Sismanidis C;Seddon JA;Jenkins HE
儿童结核病越来越被认为是全球结核病负担的重要组成部分，2015年估计有100万例。虽然年龄较小的儿童易患严重的结核病，但没有按年龄分列的儿童结核病死亡率估计数，结核病从未被列入5岁以下儿童死亡率的官方估计数。我们的目标是使用一种不依赖于生命登记数据的补充方法来估算全球儿童死亡率负担。在这项数学建模研究中，我们使用基于病例死亡率的方法估计了217个国家和地区5岁以下儿童和5-14岁儿童的死亡率。我们使用儿童结核病报告数据以及艾滋病毒和抗逆转录病毒治疗估计值，按年龄、艾滋病毒和治疗状况对世卫组织儿童结核病发病率估计值进行分类。然后，我们应用系统评价证据对相应的病死率。我们估计，2015年全球有239，000（95%不确定区间[UI] 194，000-298，000）名15岁以下儿童死于结核病;其中80%（191，000，95%UI 132，000-257，000）为5岁以下儿童。 超过70%（182，000，140，000-239，000）的死亡发生在世卫组织东南亚和非洲地区。 我们估计，全世界有39000例（17%，23000 - 73000）儿童结核病死亡是艾滋病毒感染的儿童，其中 31000例（36%，19000 - 59000）在世卫组织非洲区域。 在所有结核病死亡中，超过96%（230 000，185 000-289 000）发生在未接受结核病治疗的儿童中。 结核病是全世界儿童死亡的十大原因之一，也是以前对5岁以下儿童死亡率分析中的一个关键遗漏。几乎所有这些死亡都发生在未接受结核病治疗的儿童中，这意味着减少这一负担的空间很大。国际药品采购机制、国家卫生研究院和国家卫生研究所。
Tuberculosis in children is increasingly recognised as an important component of the global tuberculosis burden, with an estimated 1 million cases in 2015. Although younger children are vulnerable to severe forms of tuberculosis disease, no age-disaggregated estimates of paediatric tuberculosis mortality exist, and tuberculosis has never been included in official estimates of under-5 child mortality. We aimed to produce a global mortality burden estimate in children using a complementary approach not dependent on vital registration data. In this mathematical modelling study, we estimated deaths in children younger than 5 years and those aged 5–14 years for 217 countries and territories using a case-fatality-based approach. We used paediatric tuberculosis notification data and HIV and antiretroviral treatment estimates to disaggregate the WHO paediatric tuberculosis incidence estimates by age, HIV, and treatment status. We then applied systematic review evidence on corresponding case-fatality ratios. We estimated that 239 000 (95% uncertainty interval [UI] 194 000–298 000) children younger than 15 years died from tuberculosis worldwide in 2015; 80% (191 000, 95% UI 132 000–257 000) of these deaths were in children younger than 5 years. More than 70% (182 000, 140 000–239 000) of deaths occurred in the WHO southeast Asia and Africa regions. We estimated that 39 000 (17%, 23 000–73 000) paediatric tuberculosis deaths worldwide were in children with HIV infections, with 31 000 (36%, 19 000–59 000) in the WHO Africa region. More than 96% (230 000, 185 000–289 000) of all tuberculosis deaths occurred in children not receiving tuberculosis treatment. Tuberculosis is a top ten cause of death in children worldwide and a key omission from previous analyses of under-5 mortality. Almost all these deaths occur in children not on tuberculosis treatment, implying substantial scope to reduce this burden. UNITAID, National Institutes of Health, and National Institute for Health Research.