Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries.

Brendon Stubbs,Sameen Siddiqi,Helen Elsey,Najma Siddiqi,Eugenia Romano,Ruimin Ma,Kamran Siddiqi,Ai Koyanagi

doi:10.3390/ijerph18052439

Abstract

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

Highlights

Except for visual impairment, all non-communicable diseases (NCDs) were significantly associated with TB with strong associations (i.e., odds ratios (ORs) ≥3) observed for asthma, angina, and depression
Our results suggest that male sex, lower levels of wealth and education, smoking, prevalence of NCDs and associated multimorbidity were significantly higher among people with TB than those without a TB diagnosis
Our data utilizing information from 48 low- and middle-income countries (LMICs) suggests that TB is consistently associated with multiple NCDs including key physical and mental health conditions

Summary

Introduction

Tuberculosis (TB) is the leading cause of deaths from a single infectious disease globally [1]. There were approximately 10 million TB cases worldwide, and 1.5 million people died from TB in 2018 [1]. People from low- and middle-income countries (LMICs) are at a high risk of developing TB [2,3], with over 95% of TB cases and deaths occurring in LMICs [1]. Significant factors associated with increased risk of TB have been widely reported, including malnutrition, diabetes [4], poverty, overcrowding [5], alcoholism, smoking [6], human immunodeficiency virus (HIV) and chronic pulmonary disease [7]

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