Abstract

Tuberculosis (TB) incidence and mortality rates are still high in Sub-Saharan Africa, and the knowledge about the current patterns is valuable for policymaking to decrease the TB burden. Based on the Global Burden of Disease (GBD) study 2019, we used a Joinpoint regression analysis to examine the variations in the trends of TB incidence and mortality, and the age-period-cohort statistical model to evaluate their risks associated with age, period, and cohort in males and females from Cameroon (CAM), Central African Republic (CAR), Chad, and the Democratic Republic of the Congo (DRC). In the four countries, TB incidence and mortality rates displayed decreasing trends in men and women; except for the males from DRC that recorded an almost steady pattern in the trend of TB incidence between 1990 and 2019. TB incidence and mortality rates decreased according to the overall annual percentage changes over the adjusted age category in men and women of the four countries, and CAM registered the highest decrease. Although TB incidence and mortality rates increased with age between 1990 and 2019, the male gender was mainly associated with the upward behaviors of TB incidence rates, and the female gender association was with the upward behaviors of TB mortality rates. Males and females aged between 15–54 and 15–49 years old were evaluated as the population at high risks of TB incidence and mortality respectively in CAM, CAR, Chad, and DRC. The period and cohort relative risks (RRs) both declined in men and women of the four countries although there were some upward behaviors in their trends. Relatively to the period and cohort RRs, females and males from CAM recorded the most significant decrease compared to the rest of the countries. New public health approaches and policies towards young adults and adults, and a particular focus on elderlies’ health and life conditions should be adopted in CAM, CAR, DRC, and Chad to rapidly decrease TB incidence and mortality in both genders of the four countries.

Highlights

  • Tuberculosis (TB) incidence and mortality rates are still high in Sub-Saharan Africa, and the knowledge about the current patterns is valuable for policymaking to decrease the TB burden

  • TB age-standardized mortality rate (ASMR) was lower than the TB age-standardized incidence rate (ASIR) in both sexes, and the patterns representing the male gender are above those representing the female gender in all four countries

  • Central African Republic (CAR) recorded the highest and CAM the lowest TB ASIR and ASMR in males and females compared to the rest of the countries

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Summary

Introduction

Tuberculosis (TB) incidence and mortality rates are still high in Sub-Saharan Africa, and the knowledge about the current patterns is valuable for policymaking to decrease the TB burden. Based on the Global Burden of Disease (GBD) study 2019, we used a Joinpoint regression analysis to examine the variations in the trends of TB incidence and mortality, and the age-period-cohort statistical model to evaluate their risks associated with age, period, and cohort in males and females from Cameroon (CAM), Central African Republic (CAR), Chad, and the Democratic Republic of the Congo (DRC). Abbreviations APCM Age-period-cohort model APC Annual percentage change AAPC Average annual percent change ASIR Age-standardized incidence rate ASMR Age-standardized mortality rate CAM Cameroon CAR The Central African Republic CI Confidence interval CIR Crude incidence rate CMR Crude mortality rate Covid-19 The novel coronavirus DRC The Democratic Republic of the Congo GHDx Global Health Data exchange GBD Global Burden of Disease HDI Human Development Index HIV Human immunodeficiency virus IHME Institute of Health Metrics and Evaluation RRs Relative risks SDGs Sustainable development goals. Within the same year (2019), TB mortality rates per 100,000 people were estimated at around 22 in Chad, 29 in CAM, 49 in DRC, and 98 in CAR​10

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