Quantifying the global number of tuberculosis survivors

A study utilizing South Korea's National Health Insurance Service data, which covers nearly 97% of the population, examined TB survivors diagnosed between 2010 and 2017. After excluding individuals with multidrug-resistant TB or those treated for less than six months, the study identified 205,056 TB survivors. Further exclusions were made for those with missing data, deceased within a year of diagnosis, or under 20 years old, leaving 92,897 survivors. Of these, 82,098 were matched for detailed analysis based on age and sex. The average age at diagnosis was 56.1 years, with a male predominance, and TB survivors generally had a lower BMI than controls. They also exhibited higher rates of smoking, heavy drinking, and sedentary lifestyle, alongside being more likely to come from lower income brackets and metropolitan areas.[1] See also: Lin TB Lab

The study revealed that TB survivors had poorer health outcomes, with all comorbidities except hypertension more common among them, and a higher Charlson Comorbidity Index. Over a median follow-up of 3.7 years, these survivors faced a significantly elevated mortality rate compared to controls, with a 1.62-fold increased risk of death. The mortality risk varied with demographic and lifestyle factors, peaking in those aged 40-49, and was notably higher for males, smokers, heavy drinkers, those with lower incomes or living outside metropolitan areas, and those with higher comorbidity indices. Conversely, higher BMI and regular exercise appeared to mitigate mortality risk. The type of TB also influenced mortality, with miliary or disseminated TB showing the highest risk, followed by pulmonary, extrapulmonary, and combined forms of TB.[1] See also: https://tbreadingnotes.blogspot.com/2024/07/health-system-delay-among-patients-with.html

Tuberculosis survivors face significant health challenges, including a higher risk of TB recurrence and increased mortality rates regardless of treatment adequacy. They are prone to chronic respiratory diseases, exhibiting symptoms like abnormal lung function, which often leads to chronic symptoms and reduced exercise capacity. Additionally, these individuals have an elevated risk for cardiovascular disease and respiratory-related hospital admissions, contributing to a diminished quality of life and enduring social stigma. Socially and economically, TB survivors contend with ostracism and stigma, which can impact personal relationships and social integration. The financial toll from medical expenses and loss of income during treatment can push families into poverty, affecting not only the patients but also the well-being and education of their children.[2]

The scale of TB's impact is vast, with around 155 million survivors in 2020, highlighting a significant population dealing with post-recovery disabilities, thus affecting the overall morbidity calculations for TB. Healthcare for these survivors requires a multifaceted approach, integrating TB care with general health services to address their complex needs, including lung function evaluations and treatments to manage ongoing respiratory issues. In lower-income settings, interventions like vaccinations, pulmonary rehabilitation, and smoking cessation are vital for improving life quality. Childhood TB survivors, in particular, face lifelong lung impairments, necessitating early intervention and prevention strategies. Economically, the disease often leads to financial distress, making social support programs essential for recovery. The field also demands further research to understand the long-term lung damage, refine treatment strategies, and evaluate therapies not just for cure but for quality of life post-treatment.[2]

References:

1. Choi, H., Han, K., Jung, J.H., Park, S.H., Kim, S.H., Kang, H.K., Sohn, J.W., Shin, D.W. and Lee, H., 2023. Long-term mortality of tuberculosis survivors in Korea: a population-based longitudinal study. Clinical Infectious Diseases, 76(3), pp.e973-e981. See also: https://tbreadingnotes.blogspot.com/2024/07/non-communicable-diseases-in-tb.html

2. Dodd, P.J., Yuen, C.M., Jayasooriya, S.M., van der Zalm, M.M. and Seddon, J.A., 2021. Quantifying the global number of tuberculosis survivors: a modelling study. The Lancet Infectious Diseases, 21(7), pp.984-992. See also: https://tbreadingnotes.blogspot.com/2024/07/effects-of-smoking-and-solid-fuel-use.html