Global, regional, and national burden of tuberculosis, 1990-2016: Results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study

GBD Tuberculosis Collaborators

Research output: Contribution to journalArticle

Abstract

Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05-10·16) and the number of tuberculosis deaths was 1·21 million (1·16-1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01-1·89) and the number of tuberculosis deaths was 0·24 million (0·16-0·31). Globally, among HIV-negative individuals the agestandardised incidence of tuberculosis decreased annually at a slower rate (-1·3% [-1·5 to -1·2]) than mortality did (-4·5% [-5·0 to -4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was -4·0% (-4·5 to -3·7) and mortality was -8·9% (-9·5 to -8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV. Funding Bill & Melinda Gates Foundation.

Original languageEnglish (US)
Pages (from-to)1329-1349
Number of pages21
JournalThe Lancet Infectious Diseases
Volume18
Issue number12
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

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Tuberculosis
Wounds and Injuries
Mortality
Incidence
HIV
Global Burden of Disease
Conservation of Natural Resources
North America
Oceania
Demography
Southern Africa
Eastern Europe
Multidrug-Resistant Tuberculosis
Africa South of the Sahara
Birth Rate
Information Storage and Retrieval
Tuberculin
Drug Resistance
Uncertainty
Cause of Death

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Global, regional, and national burden of tuberculosis, 1990-2016 : Results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study. / GBD Tuberculosis Collaborators.

In: The Lancet Infectious Diseases, Vol. 18, No. 12, 01.12.2018, p. 1329-1349.

Research output: Contribution to journalArticle

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abstract = "Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95{\%} uncertainty interval [UI] 8·05-10·16) and the number of tuberculosis deaths was 1·21 million (1·16-1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01-1·89) and the number of tuberculosis deaths was 0·24 million (0·16-0·31). Globally, among HIV-negative individuals the agestandardised incidence of tuberculosis decreased annually at a slower rate (-1·3{\%} [-1·5 to -1·2]) than mortality did (-4·5{\%} [-5·0 to -4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was -4·0{\%} (-4·5 to -3·7) and mortality was -8·9{\%} (-9·5 to -8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV. Funding Bill & Melinda Gates Foundation.",
author = "{GBD Tuberculosis Collaborators} and Kyu, {Hmwe Hmwe} and Maddison, {Emilie R.} and Henry, {Nathaniel J.} and Ledesma, {Jorge R.} and Wiens, {Kirsten E.} and Robert Reiner and Biehl, {Molly H.} and Chloe Shields and Aaron Osgood-Zimmerman and Ross, {Jennifer M.} and Austin Carter and Frank, {Tahvi D.} and Haidong Wang and Vinay Srinivasan and Zegeye Abebe and Agarwal, {Sanjay Kumar} and Fares Alahdab and Alene, {Kefyalew Addis} and Ali, {Beriwan Abdulqadir} and Nelson Alvis-Guzman and Andrews, {Jason R.} and Antonio, {Carl Abelardo T.} and Suleman Atique and Atre, {Sachin R.} and Ashish Awasthi and Ayele, {Henok Tadesse} and Hamid Badali and Alaa Badawi and Aleksandra Barac and Neeraj Bedi and Masoud Behzadifar and Meysam Behzadifar and Bekele, {Bayu Begashaw} and Belay, {Saba Abraham} and Bensenor, {Isabela M.} and Butt, {Zahid A.} and F{\'e}lix Carvalho and Kelly Cercy and Christopher, {Devasahayam J.} and Daba, {Alemneh Kabeta} and Lalit Dandona and Rakhi Dandona and Ahmad Daryani and Demeke, {Feleke Mekonnen} and Kebede Deribe and Dharmaratne, {Samath Dhamminda} and Doku, {David Teye} and Manisha Dubey and Dumessa Edessa and Mohsen Naghavi",
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TY - JOUR

T1 - Global, regional, and national burden of tuberculosis, 1990-2016

T2 - Results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study

AU - GBD Tuberculosis Collaborators

AU - Kyu, Hmwe Hmwe

AU - Maddison, Emilie R.

AU - Henry, Nathaniel J.

AU - Ledesma, Jorge R.

AU - Wiens, Kirsten E.

AU - Reiner, Robert

AU - Biehl, Molly H.

AU - Shields, Chloe

AU - Osgood-Zimmerman, Aaron

AU - Ross, Jennifer M.

AU - Carter, Austin

AU - Frank, Tahvi D.

AU - Wang, Haidong

AU - Srinivasan, Vinay

AU - Abebe, Zegeye

AU - Agarwal, Sanjay Kumar

AU - Alahdab, Fares

AU - Alene, Kefyalew Addis

AU - Ali, Beriwan Abdulqadir

AU - Alvis-Guzman, Nelson

AU - Andrews, Jason R.

AU - Antonio, Carl Abelardo T.

AU - Atique, Suleman

AU - Atre, Sachin R.

AU - Awasthi, Ashish

AU - Ayele, Henok Tadesse

AU - Badali, Hamid

AU - Badawi, Alaa

AU - Barac, Aleksandra

AU - Bedi, Neeraj

AU - Behzadifar, Masoud

AU - Behzadifar, Meysam

AU - Bekele, Bayu Begashaw

AU - Belay, Saba Abraham

AU - Bensenor, Isabela M.

AU - Butt, Zahid A.

AU - Carvalho, Félix

AU - Cercy, Kelly

AU - Christopher, Devasahayam J.

AU - Daba, Alemneh Kabeta

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Daryani, Ahmad

AU - Demeke, Feleke Mekonnen

AU - Deribe, Kebede

AU - Dharmaratne, Samath Dhamminda

AU - Doku, David Teye

AU - Dubey, Manisha

AU - Edessa, Dumessa

AU - Naghavi, Mohsen

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05-10·16) and the number of tuberculosis deaths was 1·21 million (1·16-1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01-1·89) and the number of tuberculosis deaths was 0·24 million (0·16-0·31). Globally, among HIV-negative individuals the agestandardised incidence of tuberculosis decreased annually at a slower rate (-1·3% [-1·5 to -1·2]) than mortality did (-4·5% [-5·0 to -4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was -4·0% (-4·5 to -3·7) and mortality was -8·9% (-9·5 to -8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV. Funding Bill & Melinda Gates Foundation.

AB - Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05-10·16) and the number of tuberculosis deaths was 1·21 million (1·16-1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01-1·89) and the number of tuberculosis deaths was 0·24 million (0·16-0·31). Globally, among HIV-negative individuals the agestandardised incidence of tuberculosis decreased annually at a slower rate (-1·3% [-1·5 to -1·2]) than mortality did (-4·5% [-5·0 to -4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was -4·0% (-4·5 to -3·7) and mortality was -8·9% (-9·5 to -8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV. Funding Bill & Melinda Gates Foundation.

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