Tuesday, March 24, 2026

LTBI among Household Contacts of Drug-sensitive Pulmonary TB Patients in Medan, Indonesia [TBN 054]

WHAT

This study examined the prevalence of latent tuberculosis infection (LTBI) among household contacts of pulmonary tuberculosis (TB) patients in Medan, Indonesia. Among 102 household contacts of 62 drug-sensitive pulmonary TB index cases, 30 individuals (29.41%) were diagnosed with LTBI, 60 individuals (58.82%) tested negative, and 12 individuals were diagnosed with active pulmonary TB and excluded from the LTBI analysis. Thus, the final analytic sample included 90 household contacts.

The study also evaluated potential risk factors associated with LTBI, including age, sex, occupation, educational level, nutritional status, comorbidities, smoking behavior, alcohol consumption, and duration of household contact. The majority of participants were female (76.6%), with the most common age group among LTBI cases being 46–55 years, while the non-LTBI group was most commonly aged 26–35 years. Most participants had senior high school education, did not smoke, did not consume alcohol, and reported no comorbidities. Contact duration of ≥5 hours per day was common in both groups.

Bivariate analysis demonstrated that none of the assessed variables were significantly associated with LTBI. Specifically, age, gender, educational level, occupation, nutritional status, comorbidities, smoking, alcohol consumption, and contact duration showed no statistically significant relationship with LTBI occurrence (p > 0.05). These findings suggest that LTBI among household contacts may occur regardless of commonly measured demographic, behavioral, or clinical risk factors.

Overall, the study found a relatively high prevalence of LTBI among household contacts of pulmonary TB patients. The authors concluded that these findings highlight the importance of strengthening contact investigation programs and expanding TB preventive treatment among household contacts, particularly in high-burden urban settings such as Medan.

HOW

This study used a cross-sectional design conducted in Medan, an urban city and the capital of North Sumatra, Indonesia, with a population of approximately 2.47 million people. Pulmonary TB index cases were identified from hospitals, clinics, and community health centers (Puskesmas). Eligible index cases were pulmonary TB patients with sputum positive for Mycobacterium tuberculosis and rifampicin-sensitive results confirmed using the Xpert MTB/RIF test. Verification of index cases was performed using the Indonesian Tuberculosis Information System (SITB).

Household contacts aged 15 years and older who lived in the same household as pulmonary drug-sensitive TB patients and consented to participate were recruited using consecutive sampling between October 1 and December 5, 2023. Family members of extrapulmonary TB patients and individuals diagnosed with active TB during contact investigation were excluded. The minimum sample size calculated using the Lemeshow formula was 99 participants, and 102 household contacts were ultimately enrolled.

Data collection included structured interviews, anthropometric measurements, Interferon-Gamma Release Assay (IGRA) testing, chest X-ray examination, and sputum testing when clinically indicated. Interviews collected demographic information, education, occupation, smoking behavior, alcohol consumption, comorbidities, and duration of contact with the index case. Nutritional status was assessed using body mass index derived from height and weight measurements.

LTBI was defined as a positive QuantiFERON-TB Gold Plus (QFT-Plus) IGRA result with a normal chest X-ray and absence of TB symptoms. Participants with abnormal chest X-ray findings or symptoms suggestive of TB underwent sputum examination using Xpert MTB/RIF testing. Individuals diagnosed with active TB, either microbiologically confirmed or clinically diagnosed, were excluded from the LTBI analysis.

Source: Sinaga, B.Y.M., Siregar, J., Sormin, D.E., Sundari, R. and Samodra, Y.L., 2025. Latent Tuberculosis Infection among Household Contacts of Drug-sensitive Pulmonary Tuberculosis Patients: A Cross-sectional Study from Medan, Indonesia. Acta Medica Philippina, 59(19), p.84-90.

Monday, March 23, 2026

Long-term risk of death after tuberculosis diagnosis and treatment [TBN 053]

What

Tuberculosis (TB) is widely recognized as a treatable and curable disease, yet this study shows that its consequences extend far beyond the active infection phase. Individuals who survive TB continue to face a significantly elevated risk of death for many years after diagnosis and even after completing treatment. This long-term mortality burden is largely overlooked in public health frameworks, with no dedicated guidance from global authorities such as the WHO to address post-TB health risks. The persistence of this risk is thought to arise from a combination of biological damage—such as permanent lung impairment and chronic inflammation—as well as ongoing social and health vulnerabilities, including comorbid conditions and poverty.

The magnitude and duration of excess mortality are substantial. Immediately after TB diagnosis, mortality risk is extremely high, particularly within the first month, and although it declines over time, it remains elevated even 14 years later. Individuals who complete treatment fare better than those newly diagnosed, but still experience roughly double the mortality risk of comparable TB-free individuals over the long term. Importantly, this is not just a relative effect; the absolute number of excess deaths is large, indicating a significant population-level burden that persists well beyond clinical recovery.

This increased mortality risk spans multiple causes of death rather than being limited to TB-related complications. Elevated risks are observed for cardiovascular disease, respiratory conditions, cancer, and metabolic disorders. Certain patterns stand out: respiratory and cancer-related deaths are particularly high shortly after diagnosis or treatment, while cardiovascular mortality becomes more prominent over time. Additionally, deaths from external causes—especially assaults—are also higher among TB-affected individuals, suggesting that social determinants and environmental risks play a meaningful role alongside biological factors.

The impact of TB on mortality is not uniform across populations. Younger adults show higher relative risks, whereas older individuals bear a greater absolute burden of excess deaths. Differences by sex are modest, though slightly higher risks are observed among women in some contexts. Disease severity also matters: individuals with extrapulmonary or mixed forms of TB tend to have worse outcomes than those with pulmonary TB alone. Comorbidities further amplify risk, with diabetes emerging as a particularly important factor—associated with even greater absolute excess mortality than HIV in this study. Notably, household contacts of TB patients also exhibit modestly increased mortality, reinforcing the role of shared socioeconomic and environmental exposures.

How

This study was designed as a large-scale retrospective cohort analysis using nationwide administrative data from Brazil. It leveraged the “100 Million Brazilian Cohort,” which captures over 130 million individuals enrolled in social welfare programs and represents predominantly low-income populations. These data were linked to national TB notification records and mortality registries, allowing researchers to follow individuals over time and assess long-term outcomes with high completeness and reliability. The study period spanned from 2004 to 2018, providing sufficient duration to evaluate long-term mortality trends.

Two main exposure groups were defined: individuals at the time of TB diagnosis and individuals who had successfully completed TB treatment. Each exposed individual was matched to a TB-free control using exact matching on a wide range of demographic and socioeconomic variables, including age, sex, race or ethnicity, geographic location, housing conditions, and household characteristics. This matching approach was designed to minimize confounding by ensuring that exposed and unexposed groups were highly comparable at baseline, particularly with respect to social determinants of health.

The study focused primarily on “natural deaths,” defined as deaths excluding TB, HIV, and external causes, in order to isolate the indirect and longer-term physiological consequences of TB. Secondary outcomes included all-cause mortality and specific causes of death, such as cardiovascular disease, cancer, respiratory illness, metabolic disorders, and external causes like accidents and assaults. Mortality outcomes were classified using standardized ICD-10 codes, enabling consistent categorization across the dataset.

Participants were followed from the point of TB diagnosis or treatment completion until death, the end of the study period, or (for controls) a subsequent TB diagnosis. Statistical analysis used the Aalen–Johansen estimator to calculate cumulative incidence while accounting for competing risks from different causes of death. Key measures included risk ratios, incidence rate ratios, and absolute risk differences, providing both relative and population-level perspectives on mortality risk over time.

To ensure data quality and interpretability, several exclusion criteria were applied, including removal of individuals with missing key variables, implausible dates, prior TB diagnoses before cohort entry, or extreme ages. Additional subgroup analyses were conducted to examine variation in mortality risk by age, sex, comorbidities, TB type, and household exposure. The study also incorporated analyses of household contacts, allowing for comparison between TB patients and individuals sharing similar living environments, further strengthening the interpretation of both biological and social drivers of long-term mortality.

Source: Cerqueira-Silva, T., Boaventura, V.S., Paixão, E.S., Sanchez, M., Leyrat, C., Ranzani, O., Barreto, M.L. and Pescarini, J.M., 2026. Long-term risk of death after tuberculosis diagnosis and treatment. Nature Medicine, pp.1-8.

Thursday, February 5, 2026

Medication Adherence among Drug-Resistant Tuberculosis Patients at UI Hospital

Who

The study involved 87 drug-resistant tuberculosis (DR-TB) patients aged 18 years or older who were receiving treatment and attending routine monthly follow-up visits at Universitas Indonesia Hospital. Most participants were male and aged 18–59 years.

What

The study assessed medication adherence levels among DR-TB patients. Results showed that 50.6% of patients had low adherence, 47.1% moderate adherence, and only 2.3% high adherence. Adherence was significantly associated with gender, and tended to be higher among females, patients aged 18–59 years, those with secondary education, new TB cases, and patients receiving long-term treatment regimens.

When

The study was conducted between February and March 2024.

Where

The research took place at Universitas Indonesia Hospital in Depok City, Indonesia.

Why

The study aimed to evaluate treatment adherence among DR-TB patients, as poor adherence can compromise treatment effectiveness, prolong therapy, and increase the risk of poor clinical outcomes in DR-TB management.

How

An observational cross-sectional study design was used. Data were collected using the validated Indonesian version of the Morisky Medication Adherence Scale (MMAS-8). Adherence scores were classified into low (<6), moderate (6 to <8), and high (8). Associations between patient characteristics and adherence levels were analyzed.

Source: Harahap, D.W.S., Andrajati, R., Sari, S.P. and Handayani, D., 2024. Medication Adherence among Drug-Resistant Tuberculosis (DR-TB) Patients at Universitas Indonesia Hospital. Jurnal Respirologi Indonesia, 44(3), pp.196-200.

The association between TB–HIV coinfection and DR-TB treatment failure

Who

The study included 4,261 drug-resistant tuberculosis (DR-TB) patients aged 15 years or older who were diagnosed, treated, and recorded in the Indonesian Tuberculosis Information System (SITB) during 2022–2023. Among them, 153 patients had TB–HIV coinfection and 4,108 did not. Patients who were lost to follow-up (1,051 cases) were excluded.

What

The study examined the association between TB–HIV coinfection and DR-TB treatment failure. The findings showed that TB–HIV coinfection was significantly associated with a higher risk of treatment failure. After adjusting for age, patients with TB–HIV coinfection had a 2.3 times higher risk of DR-TB treatment failure compared with patients without TB–HIV coinfection.

When

Data were collected from the 2022–2023 SITB database, with treatment outcomes evaluated up to 2023, accounting for the long duration of DR-TB treatment (up to 20 months).

Where

The study was conducted in Indonesia, using nationwide data from the Indonesian Tuberculosis Information System (SITB).

Why

The research aimed to address the limited evidence on whether TB–HIV coinfection contributes to DR-TB treatment failure in Indonesia, while controlling for important confounding factors such as age, TB–DM coinfection, sex, and type of anti-tuberculosis drug regimen.

How

An observational analytic retrospective cohort design was used with secondary data from SITB. DR-TB diagnosis was based on Xpert MTB/RIF testing. HIV status was determined using HIV rapid tests, and TB–DM coinfection was assessed using rapid blood glucose tests. Treatment outcomes were categorized into treatment failure and treatment success. Statistical analyses included bivariate analysis, stratified analysis, homogeneity testing, and multivariable logistic regression to identify confounders and calculate adjusted odds ratios (AORs).

Source: Laili, F., Ronoatmodjo, S. and Murtiani, F., 2024. Ko-Infeksi TB-HIV terhadap Kegagalan Pengobatan Pasien Tuberkulosis Resistan Obat di Indonesia. The Indonesian Journal of Infectious Diseases, 10(2), pp.153-165.

Wednesday, February 4, 2026

The potential effect of a geographically focused intervention against TB in the USA

Who

Study population: People aged ≥15 years diagnosed with tuberculosis (TB) in the USA.
Data source: National TB Surveillance System (NTSS).
Time period: 2011–2019.
Key subgroups: Racially and ethnically minoritised populations (Black, Hispanic, Asian, American Indian or Alaska Native [AIAN], and other non-White groups).
Exclusions: People incarcerated at TB diagnosis (3.9% of racially minoritised cases).
Intervention-eligible groups: People born outside the USA, people living with HIV, and people experiencing homelessness.

What

Objective: To estimate the health impact, cost, cost-effectiveness, and equity effects of a one-time targeted latent tuberculosis infection (LTBI) testing and treatment intervention.
Key findings:
- Targeting the top 5% of US counties with the highest TB risk among racially minoritised populations captured 47.4% of all TB cases.
- The intervention was estimated to avert:
  - 17,359 TB cases
  - 2,700 TB deaths
  - 14,951 QALYs gained over participants’ lifetimes.
- 94.1% of people with LTBI in intervention counties were racially minoritised.
- The intervention reduced TB incidence across most racial and ethnic groups and modestly reduced racial and ethnic disparities, especially for Black people.
- Cost-effectiveness: $86,177 per QALY gained (2022 USD).

When

TB surveillance data: 2011–2019.
Projection period for impact on incidence and disparities: 2026–2040.
Post-2020 data excluded due to COVID-19–related disruptions in TB diagnosis.

Where

Geographic scope: All 50 US states and the District of Columbia.
Intervention focus: 157 counties (top 5% by a TB risk score combining TB incidence among racially minoritised people and their population share).

Why

Rationale: TB incidence remains disproportionately high among racially and ethnically minoritised populations in the USA.
Policy challenge: Current US guidelines do not allow LTBI testing to be restricted by race or ethnicity, necessitating a strategy that:
- Reduces disparities,
- Maximizes population health impact,
- Remains guideline-concordant and cost-effective.
Goal: Inform resource allocation and decision making for TB elimination efforts.

How

Design: Modeling study combining surveillance data, statistical smoothing, and economic simulation.
Targeting approach:
1. County-level targeting: Selected counties with highest TB burden among racially minoritised populations.
2. Individual-level targeting: Offered LTBI testing to all people with guideline-recommended risk factors, regardless of race or ethnicity.
LTBI estimation: Back-calculated from TB incidence using published reactivation rates and spatially smoothed generalized additive models.
Intervention: Interferon gamma release assay testing, followed by 3 months of weekly isoniazid plus rifapentine.
Analysis:
- Markov cohort model for lifetime health and economic outcomes.
- Incremental cost-effectiveness ratios (ICERs) estimated from a TB health services perspective.
- Quasi-Poisson models projected future TB incidence and disparities.
Oversight: Analysis of de-identified surveillance data reviewed by the Centers for Disease Control and Prevention, classified as research not involving human participants.

Overall conclusion

A geographically focused, guideline-concordant LTBI testing and treatment intervention could produce substantial health gains, be moderately cost-effective, and achieve small but meaningful reductions in racial and ethnic TB disparities, supporting its use as a strategic tool for TB elimination in the USA.

Source: Regan, M., Cui, H., Swartwood, N.A., Li, Y., Marks, S.M., Barham, T., Khan, A., Winston, C.A., Cohen, T., Horsburgh, C.R. and Salomon, J.A., 2026. The potential effect of a geographically focused intervention against tuberculosis in the USA: a simulation modelling study. The Lancet Public Health, 11(2), pp.e82-e91.

Monday, February 2, 2026

Socioeconomic Burden, Stigma, and Prevention Strategies in Tuberculosis

The financial consequences of tuberculosis (TB) are broadly classified into direct and indirect costs. Direct costs include medical expenses such as drugs, laboratory tests, physician fees, radiological investigations, and hospitalization. These costs are often high relative to per capita income and place a substantial burden on household finances, particularly in low- and middle-income countries. Indirect costs arise from illness-related loss of income, reduced work capacity, and decreased labor supply due to disability or death. TB also imposes significant pressure on healthcare systems through increased hospital expenditures and welfare costs, although potential revenues could be generated through effective cost recovery for services such as diagnostics, drugs, radiology, and human resources.

Tuberculosis remains highly stigmatized in many communities, primarily due to fear of transmission, but also because of its strong association with HIV, poverty, low social status, malnutrition, and socially disapproved behaviors. This stigma can lead to social isolation, abandonment by family, exclusion from workplaces or communities, and job loss. Negative and often poorly informed societal perceptions reinforce discrimination against TB patients. Because TB has long been associated with poverty, poor hygiene, and social marginalization, affected individuals may face social disregard. Limited awareness and misinformation contribute significantly to this prejudice, and in some cases, stigma within healthcare settings further compromises access to diagnosis, treatment adherence, and clinical outcomes.

Tuberculosis and malnutrition are closely linked, with malnutrition acting both as a risk factor for infection and as a consequence of disease. Malnutrition is associated with poorer prognosis, increased mortality, and false-negative tuberculin test results, which may delay diagnosis. Nutritional deficiencies can cause secondary immunodeficiency, increasing susceptibility to TB. Conversely, TB reduces appetite, impairs nutrient absorption, alters metabolism, and leads to muscle wasting due to impaired protein utilization. Deficiencies in micronutrients such as zinc, selenium, iron, copper, and vitamins A, C, D, and E further compromise immune function. Low serum vitamin D levels have been observed in patients with active TB and multidrug-resistant TB during treatment. Improving nutritional status and providing adequate supplementation may support recovery and represent an effective strategy for TB control in resource-limited settings.

Since the introduction of antibiotics in the 1940s, tuberculosis has become a treatable disease. Current TB elimination strategies focus on early detection and treatment of active cases to interrupt transmission, alongside screening and treatment of latent TB infection to prevent disease progression.

Bacillus Calmette-Guérin (BCG) vaccination is the most widely administered vaccine worldwide and provides protection against severe forms of TB in young children, particularly miliary and disseminated disease. However, it does not consistently protect against pulmonary TB.

To improve adherence in the treatment of latent TB infection, the World Health Organization has recommended since 2020 a three-month regimen of weekly rifapentine and isoniazid (3HP).

Close contact remains an important route of TB transmission. Even routine parental behaviors such as kissing children may pose a risk when caregivers are infected, highlighting the need for awareness and preventive caution.

Following the introduction of X-rays in 1895, chest radiography became an essential tool for identifying pulmonary TB lesions. From the 1940s onward, radiographic screening enabled earlier detection of active disease, including cases without overt clinical symptoms, allowing timely initiation of treatment and improved disease control.

Source: Varotto, E., Martini, M., Vaccarezza, M., Vittori, V., Mietlińska-Sauter, J., Gelsi, R., Galassi, F.M. and Papa, V., 2025. Historical and Social Considerations upon Tuberculosis. Journal of Preventive Medicine and Hygiene, 66(1), pp.E145-E152.

Friday, January 30, 2026

Global estimates of tuberculosis incidence during pregnancy and postpartum

Background

Tuberculosis (TB) incidence peaks among women of reproductive age (15–49 years), encompassing all individuals who can become pregnant. Pregnancy and the postpartum period are associated with an increased risk of progression to active TB disease compared with non-pregnant periods. Maternal TB is linked to severe adverse outcomes, including low birthweight, preterm birth, stillbirth, maternal mortality, and infant mortality. Postpartum TB, in particular, contributes substantially to maternal and infant deaths, especially among women living with HIV.

Despite these risks, tuberculosis preventive treatment (TPT) is rarely used during pregnancy due to persistent safety concerns, even though it is not contraindicated. TB diagnosis during pregnancy is challenging because TB symptoms (e.g., fatigue, shortness of breath) overlap with normal pregnancy-related changes, and physiological adaptations such as gestational weight gain may mask typical disease manifestations. Furthermore, pregnancy status is not routinely recorded in TB surveillance systems, and TB cases are not systematically captured in maternal health registers, leading to under-recognition of the burden of TB during pregnancy and the postpartum period.

Who

Women of reproductive age (15–49 years) globally, including both HIV-negative women and women living with HIV.
The study population was derived from global demographic and disease datasets rather than a single cohort. Evidence inputs included six published observational studies (two case–control and four retrospective cohort studies) contributing to the meta-analysis, as well as an additional cohort dataset of women living with HIV from South Africa (the ORCHID trial).

What

The study estimated global and country-specific TB incidence during pregnancy and the postpartum period, stratified by age and HIV status.

Key findings:

Pregnancy and the postpartum period were associated with increased TB risk compared with non-pregnant periods.
Among HIV-negative women, the pooled incidence rate ratio (IRR) was 1.34 during pregnancy and 1.91 postpartum.
Among women living with HIV, TB risk was substantially higher, with IRRs of 5.73 during pregnancy and 3.58 postpartum (based on ORCHID data).
In 2023, an estimated 239,500 pregnant women and 97,600 postpartum women developed active TB globally, accounting for approximately 9% of TB incidence among women aged ≥15 years.

The authors conclude that TB during pregnancy and postpartum represents a substantial and under-recognised global burden with major implications for maternal, neonatal, and infant health.

When

Included studies were published between 1996 and 2020, with observation periods spanning 1992 to 2014.
Modelled TB burden estimates were generated for the year 2023.

Where

The analysis was global, producing country- and region-specific estimates.
Meta-analysis data were drawn from six countries: the Dominican Republic, Malawi, Mongolia, South Africa, Sweden, and the United Kingdom.
The highest estimated TB burden among pregnant and postpartum women occurred in the WHO African Region, followed by the WHO South-East Asia Region.

Why

The study addressed a critical gap in global TB burden estimation, as routine TB surveillance systems do not disaggregate incidence by pregnancy or postpartum status. Improved estimates are needed to better characterise TB risk during these periods and to inform integrated TB, maternal, and HIV health strategies, particularly in high HIV-prevalence settings.

How

The authors used a multi-step analytical approach:

A rapid literature review and meta-analysis using a PECOS framework to estimate IRRs for TB during pregnancy and postpartum.
Conversion of odds ratios to IRRs when required, with pooling via inverse-variance weighting and heterogeneity assessed using I² and τ² statistics.
A mathematical modelling framework integrating age- and sex-disaggregated TB incidence data from the World Health Organization, fertility and population data from the UN World Population Prospects 2024, and HIV prevalence data from UNAIDS.
Estimation of person-time at risk assuming 9 months of pregnancy and 3 months postpartum.
Disaggregation of TB incidence by HIV status and adjustment using meta-analytic IRRs, with uncertainty propagated across all model inputs.

Overall Interpretation

Pregnant and postpartum women—particularly those living with HIV—face a markedly elevated risk of tuberculosis. Pregnancy and the postpartum period represent critical but under-addressed windows for TB prevention, screening, and integrated maternal–TB–HIV care at the global level.

Source: Mafirakureva, N., Cartledge, A., Bradshaw, I., Bekker, A., Salazar-Austin, N., Meehan, S.A., Myer, L., Odayar, J., Rangaka, M.X. and Dodd, P.J., 2026. Global estimates of tuberculosis incidence during pregnancy and postpartum: a rapid review and modelling analysis. The Lancet Global Health.

Thursday, January 29, 2026

Burden of TB, 1990–2050: a comparative analysis of GBD 2021 and WHO surveillance systems

Who

Population: Global population, stratified by age, sex, Sociodemographic Index (SDI) quintiles, regions, and countries.
Geographic focus: Worldwide, with detailed analyses for eight high-burden countries (India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh, Democratic Republic of the Congo) plus Hong Kong SAR, Macau SAR, and Taiwan.
Data sources:
- World Health Organization – Global Health Observatory (WHO-GHO)
- Institute for Health Metrics and Evaluation – Global Burden of Disease (GBD 2021)

What

Focus: Comprehensive assessment of global tuberculosis (TB) burden and trends, including TB overall, drug-susceptible TB (DS-TB), latent TB infection (LTBI), multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB).
Key findings:
- From 1990 to 2021, global age-standardized rates of TB prevalence, incidence, deaths, and DALYs declined substantially.
- DS-TB mirrored overall TB declines, while MDR-TB and XDR-TB showed earlier peaks followed by plateauing or renewed increases in some settings.
- LTBI prevalence declined steadily but remained very high globally.
- Low-SDI regions consistently bore the highest DALY burdens.
- Smoking, high alcohol consumption, and elevated fasting plasma glucose were the leading modifiable risk factors for TB-related DALYs.
- Projections to 2050 suggest continued declines overall, but rising XDR-TB incidence and mortality in some regions (notably Indonesia and the Western Pacific).
- WHO-GHO and GBD 2021 estimates broadly agreed on totals but diverged in rates and stratification, especially in high-burden countries.

When

Historical analysis: 1990–2021
Comparative database analysis: 2000–2021
Projections: 1990–2050 (GBD 2019 foresight scenarios)

Where

Global scope, with regional analyses across 21 GBD regions.
Country-level analyses for 204 countries/territories, emphasizing high TB burden settings.

Why

To address gaps in understanding:
- Long-term spatiotemporal trends in TB and its subtypes.
- Geographic hotspots and vulnerable populations.
- The contribution of modifiable risk factors to TB-related disability.
- Systematic discrepancies between WHO-GHO and GBD estimates that affect surveillance, policy-making, and health-system planning.

How

Study design: Multidimensional secondary data analysis.
Data sources & tools:
- GBD 2021 taxonomy and estimates (DisMod-MR 2.1, CODEm).
- WHO-GHO TB indicators.
- GBD Compare, Results Tool, and SCImago Graphica.
Methods:
- Age-standardized rates for prevalence, incidence, deaths, and DALYs.
- Comparative risk assessment using population-attributable fractions (PAFs).
- SDI-stratified analyses.
- Joinpoint (linkage-point) regression for trend detection and APC estimation.
- LOESS smoothing for WHO–GBD trajectory comparisons.
Outputs: Global, regional, and national trend analyses; risk-factor attribution; future projections; and cross-database concordance assessment.

Overall interpretation:
The study demonstrates substantial global progress against TB since 1990, but highlights persistent inequities, emerging threats from drug-resistant TB, and important methodological differences between global data systems, underscoring the need for targeted prevention, risk-factor modification, and harmonized surveillance.

Source: Jiang, F., Li, X., Qiao, Q., Zhang, M., Tian, Y., Zhou, S., Li, Y., Ni, R., Liu, Y., Zhang, L. and Gong, W., 2026. Global, regional, and national burden of tuberculosis, 1990–2050: a systematic comparative analysis based on retrospective cross-sectional of GBD 2021 and WHO surveillance systems. International Journal of Surgery, 112(1), pp.250-269.

Tuesday, January 27, 2026

Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan

Who

Participants: Older adult patients with tuberculosis (TB)
Sample size: 126 patients included in final analysis
- 84 survivors
- 42 nonsurvivors
Age: ≥65 years (median age: 84 years)
Sex: 63 male patients
Key characteristics: Many patients were underweight (median BMI 19.0 kg/m²) and had relatively preserved oxygenation at admission (median PaO₂/FIO₂ 368.6 mm Hg).

What

Focus: Identification of prognostic factors associated with all-cause mortality, TB-related death, and TB-unrelated death in older patients with TB.
Main findings:
- Poor performance status (PS > 2), corticosteroid use, and low serum albumin levels (≤2.6 g/dL) were independently associated with increased all-cause mortality.
- Mortality risk increased stepwise with the number of these risk factors.
- PS was the strongest predictor of TB-related death.
- Age, corticosteroid use, and low serum albumin were independently associated with TB-unrelated death.
Implications: Functional status, immune suppression, and nutritional status are key determinants of prognosis in older patients with TB and should be carefully assessed during treatment.

When

Study period: October 2016 to April 2022
Follow-up duration: 1 year after hospital admission for TB

Where

Setting: NHO Ehime Medical Center, Japan

Why

Older adults with TB experience high mortality, but prognostic factors—particularly distinguishing TB-related from TB-unrelated deaths—are not well defined.
The study aimed to address this gap to improve risk stratification and management in this vulnerable population.

How

Study design: Prospective cohort study
Inclusion criteria: Patients ≥65 years with bacteriologically confirmed TB, including extrapulmonary TB without pulmonary lesions
Exclusions: No bacteriological confirmation, prior recent TB treatment, age <65 years, or incomplete data
Data collected:
- Demographics, BMI
- Performance status (ECOG PS)
- Comorbidities and corticosteroid use
- Radiographic findings (cavities, pleural effusion)
- Laboratory data (e.g., lymphocyte count, CRP, serum albumin)
TB diagnosis: Positive culture from at least one infected site; TRCReady-80 transcription–reverse transcription concerted reaction method
Outcomes: All-cause mortality, TB-related death, TB-unrelated death
Analysis:
- Multivariate Cox proportional hazards models
- Receiver operating characteristic (ROC) curves for cutoff determination
- Kaplan–Meier survival analysis with risk stratification

Key Conclusion

Poor performance status, corticosteroid use, and hypoalbuminemia are strongly associated with mortality in older adults with TB. Comprehensive evaluation of daily functioning, physical capacity, immune status, and nutrition is critical and may directly influence prognosis.

Source: Miyoshi, S., Semba, M., Tanabe, M., Sato, C., Watanabe, A., Ito, R., Kubota, M. and Abe, M., 2025. Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan. CHEST Pulmonary, 3(2).

Monday, January 26, 2026

Spatial Econometric Analysis of the Impact of Health Infrastructure on TBC Patients

Who

Study population: Aggregated provincial-level data on Tuberculosis (TB) cases and TB incidence across Indonesia.
Units of analysis: Indonesian provinces (panel data).
Data sources:
- Health infrastructure and facilities data from the Ministry of Health Republic of Indonesia
- Control variables from the Indonesian Bureau of Statistics

What

Focus: Examines how health infrastructure and health facilities influence TB cases and TB incidence while accounting for spatial dependence between regions.
Key findings:
- TB cases in Indonesia exhibit significant positive spatial autocorrelation, with Moran’s I values ranging from 0.307 to 0.522 (significant at the 1% level), indicating clustering rather than random distribution.
- TB incidence is spatially concentrated in western Indonesia, particularly on Java Island, with the highest burden in West Java Province.
- Health infrastructure variables (households with better access to drinking water and sanitation) show no significant direct effect on TB incidence.
- Health facilities variables (number of doctors, national health insurance participation) and control variables (government healthcare expenditure and population density) have positive direct effects on TB cases.
- Indirect (spillover) effects are found only for access to drinking water and population density.
Implication: Spatial dynamics are critical for understanding TB distribution, and policy responses should account for regional clustering and spillover effects.

When

Data period: 2017–2021.

Where

Geographic setting: Indonesia, with provincial-level spatial analysis and emphasis on Java Island.

Why

TB cases may be spatially correlated due to geographic proximity, population movement, and shared environmental and socioeconomic conditions.
Ignoring spatial autocorrelation can bias estimates of determinants of TB incidence.
The study addresses the gap in understanding how health infrastructure and facilities affect TB when spatial dependence is explicitly modeled.

How

Study design: Quantitative spatial panel study.
Methods:
- Moran’s I test to detect spatial autocorrelation in TB cases and independent variables.
- Spatial econometrics modeling using the General Spatial Panel Model (GNS), including the Spatial Durbin Model with Fixed Effects (SDM-FE).
- Cluster and spatial pattern mapping using percentile and natural breaks approaches.
Analytical strategy:
- Confirm spatial correlation with Moran’s I.
- Estimate direct and indirect (spillover) effects of health infrastructure, health facilities, and control variables on TB incidence.

Source: Rahmawati, Y., Jamil, I.R., Hidayah, I., Kusumawardani, D. and Wibowo, W., 2026. Spatial Econometric Analysis of the Impact of Health Infrastructure on TBC Patients Study Case in Indonesia Provinces Level. International Review for Spatial Planning and Sustainable Development, 14(1), pp.96-117.