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Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021

Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021

Singh, Harpreet; Remuzzi, Giuseppe; Redwan, Elrashdy Moustafa Mohamed; Reddy, Murali Mohan Rama Krishna; Rawaf, Salman; Ravikumar, Nakul; Ratan, Zubair Ahmed; Rashid, Ahmed Mustafa; Singh, Jasvinder A; Rapaka, Deepthi; Rao, Sowmya J; Rao, Indu Ramachandra; Ramasamy, Shakthi Kumaran; Siraj, Md Shahjahan; Rajaa, Sathish; Siswanto, Siswanto; Solanki, Ranjan; Solomon, Yonatan; Rahmati, Masoud; Rahman, Muhammad Aziz; Rahman, Mosiur; Rahim, Fakher; Soriano, Joan B; Sreeramareddy, Chandrashekhar T; Srivastava, Vijay Kumar; Prates, Elton Junio Sady; Prashant, Akila; Steiropoulos, Paschalis; Prasad, Manya; Prabhu, Attur Ravindra Attur; Postma, Maarten J; Swain, Chandan Kumar; Pham, Hoang Tran; Perico, Norberto; Perdigão, João; Tabuchi, Takahiro; Tampa, Mircea; Tamuzi, Jacques JL Lukenze; Tat, Nathan Y; Peprah, Prince; Pepito, Veincent Christian Filipino; Peng, Minjin; Tavakoli Oliaee, Razieh; Pawar, Shrikant; Patil, Shankargouda; Parthasarathi, Ashwaghosha; Teklay, Gebrehiwot; Park, Seoyeon; Tesfaye, Edosa Geta; Parikh, Romil R; Tessema, Belay; Thangaraju, Pugazhenthan; Thapar, Rekha; Thum, Chern Choong Chern; Ticoalu, Jansje Henny Vera; Tleyjeh, Imad M; Parija, Pragyan Paramita; P A, Mahesh Padukudru; Ouyahia, Amel; Osuagwu, Uchechukwu Levi; Tobe-Gai, Ruoyan; Toma, Temesgen Mohammed; Tram, Khai Hoan; Udoakang, Aniefiok John; Umar, Tungki Pratama; Ortiz-Brizuela, Edgar; Umeokonkwo, Chukwuma David; Vahabi, Seyed Mohammad; Vaithinathan, Asokan Govindaraj; van Boven, Job F M; Oren, Eyal; Okonji, Osaretin Christabel; Okereke, Chukwuma O; Oh, In-Hwan; Odukoya, Oluwakemi Ololade; Odo, Daniel Bogale Odo; Odetokun, Ismail A; Obamiro, Kehinde O; Varthya, Shoban Babu; Oancea, Bogdan; Wang, Ziyue; Warsame, Muktar S A; Nomura, Shuhei; Westerman, Ronny; Wonde, Tewodros Eshete; Yaghoubi, Sajad; Yi, Siyan; Noman, Efaq Ali; Yon, Dong Keon; Yonemoto, Naohiro; Yu, Chuanhua; Zakham, Fathiah; Zangiabadian, Moein; Zeukeng, Francis; Zhang, Haijun; Zhao, Yang; Zheng, Peng; Zielińska, Magdalena; Salomon, Joshua A; Nnyanzi, Lawrence Achilles; Reiner Jr, Robert C; Nnaji, Chukwudi A; Naghavi, Mohsen; Niazi, Robina Khan; Vos, Theo; Nguyen, Van Thanh; Hay, Simon I; Nguyen, Dang H; Murray, Christopher J L; Kyu, Hmwe Hmwe; Negash, Hadush; Nayak, Biswa Prakash; Natto, Zuhair S; Nair, Tapas Sadasivan; Nair, Sanjeev; Naik, Gurudatta; Naik, Ganesh R; Naghavi, Pirouz; Nagarajan, Ahamarshan Jayaraman; Muthusamy, Raman; Musaigwa, Fungai; Mulita, Francesk; Mousavi, Parsa; Moore, Catrin E; Monasta, Lorenzo; Mokdad, Ali H; Xu, Yvonne Yiru; Mohammed, Hussen; Ross, Jennifer M; Moazen, Babak; Mithra, Prasanna; Misra, Arup Kumar; Misra, Sanjeev; Abbastabar, Hedayat; Mhlanga, Laurette; Abdoun, Meriem; Mestrovic, Tomislav; Merza, Muayad Aghali; Menezes, Ritesh G; Mendoza, Walter; Memish, Ziad A; Mehrotra, Ravi; Maude, Richard James; Mathur, Vasundhara; Masoumi-Asl, Hossein; Marzo, Roy Rillera; Martins-Melo, Francisco Rogerlândio; Martinez-Guerra, Bernardo Alfonso; Manilal, Aseer; Mallhi, Tauqeer Hussain; Malinga, Lesibana Anthony; Abdulah, Deldar Morad; Malik, Muhammad Sajeel Ahmed; Malhotra, Kashish; LeGrand, Kate E; Novotney, Amanda; Malakan Rad, Elaheh; Majeed, Azeem; Mahboobipour, Amir Ali; Mahajan, Preetam Bhalchandra; Lv, Hengliang; Luo, Hong; Lopukhov, Platon D; Vongpradith, Avina; Liu, Xuefeng; Liu, Chaojie; Lim, Stephen S; Lerango, Temesgen L; Lee, Seung Won; Aboagye, Richard Gyan; Abolhassani, Hassan; Chu, Huong Thi; Lee, Munjae; Ledda, Caterina; Abrha, Woldu Aberhe; Basting, Ann V L; Abubaker Ali, Hiwa; Abu-Gharbieh, Eman; Le, Thao Thi Thu; Le, Trang Diep Thanh; Aburuz, Salahdein; Addo, Isaac Yeboah; Latief, Kamaluddin; Landires, Iván; Adepoju, Abiola Victor; Adhikari, Kishor; Lal, Dharmesh Kumar; Kumar, Nithin; Kulimbet, Mukhtar; Kuddus, Md Abdul; Adnani, Qorinah Estiningtyas Sakilah; Kucuk Bicer, Burcu; Krishan, Kewal; Adra, Saryia; Afework, Abel; Aghamiri, Shahin; Koulmane Laxminarayana, Sindhura Lakshmi; Agyemang-Duah, Williams; Ahinkorah, Bright Opoku; Ahmad, Danish; Ahmad, Sajjad; Zhang, Meixin; Ma, Jianing; Ahmadzade, Amir Mahmoud; Ahmed, Haroon; Ahmed, Mohammed; Ledesma, Jorge R; Ahmed, Ayman; Akinosoglou, Karolina; AL-Ahdal, Tareq Mohammed Ali; Alam, Nazmul; Albashtawy, Mohammed; Koul, Parvaiz A; Kosen, Soewarta; Kim, Min Seo; AlBataineh, Mohammad T; Khatami, Fatemeh; Khatab, Khaled; Al-Gheethi, Adel Ali Saeed; Khan Suheb, Mahammed Ziauddin; Ali, Abid; Khan, M Nuruzzaman; Ali, Endale Alemayehu; Khan, Yusra H; Ali, Liaqat; Khamesipour, Faham; Khajuria, Himanshu; Ali, Zahid; Kaur, Navjot; Kaur, Rimple Jeet; Kassa, Gebrehiwot G; Ali, Syed Shujait Shujait; Karimi Behnagh, Arman; Karaye, Ibraheem M; Kantar, Rami S; Kanmodi, Kehinde Kazeem; Kandel, Himal; Kanchan, Tanuj; Kamble, Bhushan Dattatray; Kabir, Zubair; Joshua, Charity Ehimwenma; Joseph, Nitin; Jonas, Jost B; Allel, Kasim; Altaf, Awais; Al-Tawfiq, Jaffar A; Alvis-Guzman, Nelson; Alvis-Zakzuk, Nelson J.; Amani, Reza; Jomehzadeh, Nabi; Amusa, Ganiyu Adeniyi; Amzat, Jimoh; Andrews, Jason R; Anil, Abhishek; Anwer, Razique; Aravkin, Aleksandr Y; Areda, Damelash; Artamonov, Anton A; Janodia, Manthan Dilipkumar; Jalili, Mahsa; Jakovljevic, Mihajlo; Jafarzadeh, Abdollah; Aruleba, Raphael Taiwo; Asemahagn, Mulusew A; Atre, Sachin R; Aujayeb, Avinash; Cruz-Martins, Natália; Ismail, Faisal; Ismail, Nahlah Elkudssiah; Azadi, Davood; Islam, Md. Rabiul; Ilic, Milena D.; Ilic, Irena M.; Ikuta, Kevin S; Ibitoye, Segun Emmanuel; Huynh, Hong-Han; Hostiuc, Sorin; Hostiuc, Mihaela; Hosseinzadeh, Mehdi; Hossain, Md. Belal; Horita, Nobuyuki; Azadnajafabad, Sina; Azzam, Ahmed Y; Badar, Muhammad; Hong, Sung Hwi; Hezam, Kamal; Haubold, Johannes; Hassan, Shoaib; Hasan, Rumina Syeda; Harapan, Harapan; Hanif, Asif; Shittu, Aminu; Shirzad-Aski, Hesamaddin; Silva, João Pedro; Shetty, Ranjitha S; Sherchan, Samendra P; Sharath, Medha; Shanawaz, Mohd; Shamshirgaran, Mohammad Ali; Sham, Sunder; Shaikh, Masood Ali; Shahid, Samiah; Shah, Pritik A; Senthilkumaran, Subramanian; Senapati, Sabyasachi; Selvaraj, Siddharthan; Sawyer, Susan M; Saravanan, Aswini; Sanjeev, Rama Krishna; Samodra, Yoseph Leonardo; Samadzadeh, Sara; Samadi Kafil, Hossein; Saleh, Mohamed A; Nicholson, Sneha Ingle; Saleem, Samreen; Salami, Afeez Abolarinwa; Salam, Nasir; Sahoo, Soumya Swaroop; Sahiledengle, Biniyam; Sahebkar, Amirhossein; Saheb Sharif-Askari, Fatemeh; Singh, Surjit; Saheb Sharif-Askari, Narjes; Safi, Sher Zaman; Saeed, Umar; Saddik, Basema; Sabour, Siamak; Stafford, Lauryn K; Carter, Austin; Ruela, Guilherme de Andrade; Singh, Paramdeep; Roy, Priyanka; Rodrigues, Mónica; Dai, Xiaochen; Rezahosseini, Omid; Rezaeian, Mohsen; Rezaei, Nazila; Reyes, Luis Felipe; Bhardwaj, Pankaj; Effendi, Diyan Ermawan; Bhargava, Ashish; Bhat, Vivek; Bhatti, Jasvinder Singh; Efendi, Ferry; Ed-Dra, Abdelaziz; Bhatti, Gurjit Kaur; Bikbov, Boris; Dziedzic, Arkadiusz Marian; Dube, John; Bitra, Veera R; Bjegovic-Mikanovic, Vesna; Buonsenso, Danilo; Dsouza, Haneil Larson; Dongarwar, Deepa; Do, Thao Huynh Phuong; Burkart, Katrin; Bustanji, Yasser; Butt, Zahid A; Dhingra, Sameer; Camargos, Paulo; Dhama, Kuldeep; Cao, Yu; Carr, Sinclair; Carvalho, Felix; Cegolon, Luca; Dhali, Arkadeep; Devanbu, Vinoth Gnana Chellaiyan; Cenderadewi, Muthia; YİĞİT, Vahit; Desai, Hardik Dineshbhai; Deribe, Kebede; Derese, Awoke Masrie Asrat; Demissie, Solomon; Cevik, Muge; Chahine, Yaacoub; Chattu, Vijay Kumar; Ching, Patrick R; Demisse, Biniyam; Demessa, Berecha Hundessa; Dashti, Mahmood; Chopra, Hitesh; Darwesh, Aso Mohammad; Darega Gela, Jiregna; Darban, Isaac; Chung, Eunice; Dadras, Omid; Claassens, Mareli M; Dadana, Sriharsha; Coberly, Kaleb; Dabo, Bashir; Siddig, Emmanuel Edwar; Hamidi, Samer; Badiye, Ashish D; Hailu, Wase Benti; Bagherieh, Sara; Hailu, Semira Goitom; Hagins, Hailey; Bahadorikhalili, Saeed; Gupta, Sapna; Baig, Atif Amin; Gupta, Vivek Kumar; Banach, Maciej; Banik, Biswajit; Gupta, Veer Bala; Gultom, Novianti Br; Guled, Rashid Abdi; Gudeta, Mesay Dechasa; Guan, Shi-Yang; Goyal, Anmol; Goodridge, Amador; Ghazy, Ramy Mohamed; Bardhan, Mainak; Ghassemi, Fariba; Barqawi, Hiba Jawdat; Ghaffari, Kazem; Gebrekidan, Kahsu Gebrekirstos; Gebrehiwot, Mesfin; Gebregergis, Miglas W; Gautam, Rupesh K; Gandhi, Aravind P; Gaipov, Abduzhappar; Fischer, Florian; Fetensa, Getahun; Basharat, Zarrin; Baskaran, Pritish; Basu, Saurav; Beiranvand, Maryam; Belete, Melaku Ashagrie; Feizkhah, Alireza; Fahim, Ayesha; Fagbamigbe, Adeniyi Francis; Engelbert Bain, Luchuo; Emeto, Theophilus I; Elilo, Legesse Tesfaye; Elhadi, Muhammed; Belew, Makda Abate; Belgaumi, Uzma Iqbal; Ekundayo, Temitope Cyrus; Ekadinata, Nopryan; Beloukas, Apostolos; Eftekharimehrabad, Aziz; Bettencourt, Paulo J G; Bhagavathula, Akshaya Srikanth; Bhardwaj, Nikha
URI: http://acikerisim.sdu.edu.tr/xmlui/handle/123456789/101148

Description:

Background: Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. Methods: We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990–2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. Findings: We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5–14 years, 6·29% (5·05 to 7·70) in those aged 15–49 years, 5·72% (4·02 to 7·39) in those aged 50–69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5–14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15–49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50–69 years, and a 3·29% (–5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (–713 to 2180) fewer deaths. Interpretation: Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. Funding: Bill & Melinda Gates Foundation.

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