Global, regional, and national sex differences in the global burden of tuberculosis by HIV status

What is it about?

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.

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Photo by CDC on Unsplash

Photo by CDC on Unsplash

Why is it important?

This iteration of GBD provides tuberculosis mortality and morbidity estimates for nine new small or island countries and territories (Cook Islands, Monaco, San Marino, Nauru, Niue, Palau, Saint Kitts and Nevis, Tokelau, and Tuvalu). It also includes many new data sources and a multitude of advances in tuberculosis modelling methods. Moreover, we report for the first time how sex differences vary by sociodemographic development and the burden of HIV and tuberculosis coinfection attributable to potentially modifiable HIV risk factors (unsafe sex, intimate partner violence, and injection drug use). We also report a detailed assessment of sex differences across different measures of tuberculosis burden disaggregated by HIV status to enhance understanding of excess tuberculosis burden by sex globally. Finally, we report for the first time age-standardised, risk-deleted mortality rates along with the male-to-female ratio of risk-deleted mortality rates. Our data confirm findings from previous studies that the burden of tuberculosis is greater in males than in females. We found that males experienced substantially greater tuberculosis burden globally, with many countries estimated to have 50% higher incidence and 100% higher mortality rates for males than for females among HIV-negative individuals. Across all sociodemographic development levels, tuberculosis mortality rates were consistently greater among HIV-negative males than HIV-negative females. Among individuals with HIV and tuberculosis coinfection, mortality was higher among females than males, with unsafe sex and intimate partner violence being large contributors to the differences in the countries with the highest HIV burden.