Non-communicable diseases in TB household contacts

A study using data from the Global Burden of Disease (GBD) 2019 analyzed the impact of high fasting plasma glucose (HFPG) on tuberculosis (TB) burden from 1990 to 2019. The research highlighted a global decline in TB mortality (ASMR) and disability burden (ASDR) due to HFPG, with the most significant reductions in high socio-demographic index (SDI) regions and minimal improvements in low SDI regions. The findings aim to inform government policies on resource allocation, promote early screening, and enhance glycemic control in high-risk populations.[3]

Regional and country-specific trends showed significant variation. East Asia and high-income regions experienced the greatest reductions in TB burden, while Southern Sub-Saharan Africa, Central Asia, and Eastern Europe saw increasing trends. Low SDI countries like the Central African Republic and Somalia had persistently high TB rates, whereas countries such as Hungary and Singapore saw the largest decreases. Economic development correlated strongly with TB burden reduction, demonstrating that higher SDI levels effectively mitigate HFPG-related TB risks.[3]

Demographic disparities were also notable. Males consistently had higher TB mortality and disability rates than females, with gender differences widening in low SDI regions. Older populations, particularly those aged 45 and above, experienced slower declines in TB burden, with the oldest age groups in high SDI regions showing the least improvement. Despite global progress, TB linked to HFPG remains a significant health challenge in economically disadvantaged areas, necessitating targeted interventions for older adults and vulnerable populations.[3]

A cross-sectional study conducted in Yangon, Myanmar, from April to December 2018 explored demographic, behavioral, and health characteristics of TB patients, their household contacts, and the general population. Most household contacts were female (68.9%), while TB patients were predominantly male (66.1%). Age distribution was similar across groups, though TB patients had fewer individuals over 65 years. Behavioral risk factors were more pronounced in TB patients, who had 2.5 times and 4.6 times higher odds of smoking and drinking, respectively, compared to the general population. Household contacts also showed increased odds for these behaviors (1.7 and 2.1 times, respectively).[1]

Nutritional and metabolic disparities were significant. TB patients were seven times more likely to be underweight and had markedly lower probabilities of being overweight or obese (62% and 92% lower, respectively). They also exhibited a 6.3 times higher likelihood of diabetes mellitus (DM), with odds reducing to 3.4 when BMI-mediated pathways were considered. Conversely, TB patients and their household contacts had lower odds of hypertension, with TB patients showing up to 71% lower odds when BMI pathways were accounted for. These findings emphasize the health and behavioral differences between TB patients, their household contacts, and the general population.[1]

Integrating non-communicable disease (NCD) screening, care, and prevention into TB contact tracing offers an efficient way to maximize resources and improve cost-effectiveness. Household contacts (HHCs) of TB patients often share risk factors that make them more susceptible to NCDs, such as diabetes mellitus (DM), compared to the general population. Incorporating NCD screening during TB contact investigations enables the identification of individuals who may be unaware of their conditions, allowing for timely intervention and management. Early detection and treatment of DM among TB contacts could also help reduce the incidence of TB.[2]

The high prevalence of NCDs observed among HHCs and even among neighborhood controls underscores the necessity for community-wide screening initiatives. Notably, a significant number of undiagnosed NCD cases, particularly DM, were identified among TB contacts and community members, demonstrating the potential of integrating NCD screening into TB contact tracing efforts. This approach not only addresses the dual burden of TB and NCDs but also provides an opportunity to improve health outcomes across the broader community.[2]

References:

[1] Zayar, N.N., Chotipanvithayakul, R., Bjertness, E., Htet, A.S., Geater, A.F. and Chongsuvivatwong, V., 2023. Vulnerability of NCDs and Mediating Effect of Risk Behaviors Among Tuberculosis Patients and Their Household Contacts Compared to the General Population in the Yangon Region, Myanmar. International Journal of General Medicine, pp.5909-5920.

[2] Hamada, Y., Lugendo, A., Ntshiqa, T., Kubeka, G., Lalashowi, J.M., Mwastaula, S., Ntshamane, K., Sabi, I., Wilson, S., Copas, A. and Velen, K., 2024. A pilot cross-sectional study of non-communicable diseases in TB household contacts. IJTLD OPEN, 1(4), pp.154-159.

[3] Bian, Q., Zhang, Y., Xue, C., Lu, W., Li, W., Pan, F. and Li, Y., 2024. Global and regional estimates of tuberculosis burden attributed to high fasting plasma glucose from 1990 to 2019: emphasis on earlier glycemic control. BMC Public Health, 24(1), p.782.