Abstract
BackgroundThe health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden. Therefore, previous global and national TB burden estimates do not reflect the full consequences of surviving TB. We assessed the burden of TB including pulmonary impairment after tuberculosis in Tarrant County, Texas using Disability-adjusted Life Years (DALYs).MethodsTB burden was calculated for all culture-confirmed TB patients treated at Tarrant County Public Health between January 2005 and December 2006 using identical methods and life tables as the Global Burden of Disease Study. Years of life-lost were calculated as the difference between life expectancy using standardized life tables and age-at-death from TB. Years lived-with-disability were calculated from age and gender-specific TB disease incidence using published disability weights. Non-fatal health impacts of TB were divided into years lived-with-disability-acute and years lived-with-disability-chronic. Years lived-with-disability-acute was defined as TB burden resulting from illness prior to completion of treatment including the burden from treatment-related side effects. Years lived-with-disability-chronic was defined as TB burden from disability resulting from pulmonary impairment after tuberculosis.ResultsThere were 224 TB cases in the time period, of these 177 were culture confirmed. These 177 subjects lost a total of 1189 DALYs. Of these 1189 DALYs 23% were from years of life-lost, 2% were from years lived-with-disability-acute and 75% were from years lived-with-disability-chronic.ConclusionsOur findings demonstrate that the disease burden from TB is greater than previously estimated. Pulmonary impairment after tuberculosis was responsible for the majority of the burden. These data demonstrate that successful TB control efforts may reduce the health burden more than previously recognized.
Highlights
The health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden
Overall TB Burden (DALY) TB burden was calculated for 16 TB deaths and 161 culture-confirmed TB patients treated at TCPH between January 2005 and December 2006 using identical methods and life tables as the Global Burden of Disease Study by Murray et al [13,26]
Prior estimates of Disability-adjusted Life Years (DALYs) lost from TB included negative health effects from Years lived with disability (YLD)-acute, and years-of-life-lost, but did not include YLD-chronic [2,14,15,16,20,22,23]
Summary
The health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden. An accurate estimation of disease burden should include all known negative health effects [3,4,1120,22,23]. This is especially true for TB in low-incidence countries, where death from TB is rare and the TB disease burden may be underappreciated [2,1416,20,22,23]. The measurement of non-fatal, negative health effects is important to fully estimate TB disease burden [11,12,13,14]. Pulmonary impairment after tuberculosis was recently described as a non-fatal negative health effect [8,9,10]. Pulmonary impairment after tuberculosis has not been incorporated in assessments of TB burden [2,14,15,16,20,22,23]
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