Forecasting the impact of diabetes mellitus on tuberculosis disease incidence and mortality in India

Susanne F. Awad, Peijue Huangfu, Houssein H. Ayoub, Fiona Pearson, Soha R. Dargham, Julia A. Critchley, Laith J. Abu-Raddad

Research output: Contribution to journalArticle

Abstract

Background: In context of the rapidly expanding diabetes mellitus (DM) epidemic in India and slowly declining tuberculosis (TB) incidence, we aimed to estimate the past, current, and future impact of DM on TB epidemiology. Methods: An age-structured TB-DM dynamical mathematical model was developed and analyzed to assess the DM-on-TB impact. The model was calibrated using a literature review and meta-analyses. The DM-on-TB impact was analyzed using population attributable fraction metrics. Sensitivity analyses were conducted by accommodating less conservative effect sizes for the TB-DM interactions, by factoring the age-dependence of the TB-DM association, and by assuming different TB disease incidence rate trajectories. Results: In 1990, 11.4% (95% uncertainty interval (UI) = 6.3%-14.4%) of new TB disease incident cases were attributed to DM. This proportion increased to 21.9% (95% UI = 12.1%-26.4%) in 2017, and 33.3% (95% UI = 19.0%-44.1%) in 2050. Similarly, in 1990, 14.5% (95% UI = 9.5%-18.2%) of TB-related deaths were attributed to DM. This proportion increased to 28.9% (95% UI = 18.9%-34.1%) in 2017, and 42.8% (95% UI = 28.7%-53.1%) in 2050. The largest impacts originated from the effects of DM on TB disease progression and infectiousness. Sensitivity analyses suggested that the impact could be even greater. Conclusions: The burgeoning DM epidemic is predicted to become a leading driver of TB disease incidence and mortality over the coming decades. By 2050, at least one-third of TB incidence and almost half of TB mortality in India will be attributed to DM. This is likely generalizable to other Asian Pacific countries with similar TB-DM burdens. Targeting the impact of the increasing DM burden on TB control is critical to achieving the goal of TB elimination by 2050.

Original languageEnglish
Number of pages1
JournalJournal of global health
Volume9
Issue number2
DOIs
Publication statusPublished - 1 Dec 2019

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India
Diabetes Mellitus
Tuberculosis
Mortality
Incidence
Uncertainty
Disease Progression
Meta-Analysis
Epidemiology
Theoretical Models

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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Forecasting the impact of diabetes mellitus on tuberculosis disease incidence and mortality in India. / Awad, Susanne F.; Huangfu, Peijue; Ayoub, Houssein H.; Pearson, Fiona; Dargham, Soha R.; Critchley, Julia A.; Abu-Raddad, Laith J.

In: Journal of global health, Vol. 9, No. 2, 01.12.2019.

Research output: Contribution to journalArticle

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abstract = "Background: In context of the rapidly expanding diabetes mellitus (DM) epidemic in India and slowly declining tuberculosis (TB) incidence, we aimed to estimate the past, current, and future impact of DM on TB epidemiology. Methods: An age-structured TB-DM dynamical mathematical model was developed and analyzed to assess the DM-on-TB impact. The model was calibrated using a literature review and meta-analyses. The DM-on-TB impact was analyzed using population attributable fraction metrics. Sensitivity analyses were conducted by accommodating less conservative effect sizes for the TB-DM interactions, by factoring the age-dependence of the TB-DM association, and by assuming different TB disease incidence rate trajectories. Results: In 1990, 11.4{\%} (95{\%} uncertainty interval (UI) = 6.3{\%}-14.4{\%}) of new TB disease incident cases were attributed to DM. This proportion increased to 21.9{\%} (95{\%} UI = 12.1{\%}-26.4{\%}) in 2017, and 33.3{\%} (95{\%} UI = 19.0{\%}-44.1{\%}) in 2050. Similarly, in 1990, 14.5{\%} (95{\%} UI = 9.5{\%}-18.2{\%}) of TB-related deaths were attributed to DM. This proportion increased to 28.9{\%} (95{\%} UI = 18.9{\%}-34.1{\%}) in 2017, and 42.8{\%} (95{\%} UI = 28.7{\%}-53.1{\%}) in 2050. The largest impacts originated from the effects of DM on TB disease progression and infectiousness. Sensitivity analyses suggested that the impact could be even greater. Conclusions: The burgeoning DM epidemic is predicted to become a leading driver of TB disease incidence and mortality over the coming decades. By 2050, at least one-third of TB incidence and almost half of TB mortality in India will be attributed to DM. This is likely generalizable to other Asian Pacific countries with similar TB-DM burdens. Targeting the impact of the increasing DM burden on TB control is critical to achieving the goal of TB elimination by 2050.",
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AU - Ayoub, Houssein H.

AU - Pearson, Fiona

AU - Dargham, Soha R.

AU - Critchley, Julia A.

AU - Abu-Raddad, Laith J.

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N2 - Background: In context of the rapidly expanding diabetes mellitus (DM) epidemic in India and slowly declining tuberculosis (TB) incidence, we aimed to estimate the past, current, and future impact of DM on TB epidemiology. Methods: An age-structured TB-DM dynamical mathematical model was developed and analyzed to assess the DM-on-TB impact. The model was calibrated using a literature review and meta-analyses. The DM-on-TB impact was analyzed using population attributable fraction metrics. Sensitivity analyses were conducted by accommodating less conservative effect sizes for the TB-DM interactions, by factoring the age-dependence of the TB-DM association, and by assuming different TB disease incidence rate trajectories. Results: In 1990, 11.4% (95% uncertainty interval (UI) = 6.3%-14.4%) of new TB disease incident cases were attributed to DM. This proportion increased to 21.9% (95% UI = 12.1%-26.4%) in 2017, and 33.3% (95% UI = 19.0%-44.1%) in 2050. Similarly, in 1990, 14.5% (95% UI = 9.5%-18.2%) of TB-related deaths were attributed to DM. This proportion increased to 28.9% (95% UI = 18.9%-34.1%) in 2017, and 42.8% (95% UI = 28.7%-53.1%) in 2050. The largest impacts originated from the effects of DM on TB disease progression and infectiousness. Sensitivity analyses suggested that the impact could be even greater. Conclusions: The burgeoning DM epidemic is predicted to become a leading driver of TB disease incidence and mortality over the coming decades. By 2050, at least one-third of TB incidence and almost half of TB mortality in India will be attributed to DM. This is likely generalizable to other Asian Pacific countries with similar TB-DM burdens. Targeting the impact of the increasing DM burden on TB control is critical to achieving the goal of TB elimination by 2050.

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