Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries: a meta-review

Alexander Jarde; Eugenia Romano; Saima Afaq; Asma Elsony; Yan Lin; Rumana Huque; Helen Elsey; Kamran Siddiqi; B Stubbs; Najma Siddiqi

doi:10.1136/bmjopen-2022-060906

Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries: a meta-review

Alexander Jarde, Eugenia Romano, Saima Afaq, Asma Elsony, Yan Lin, Rumana Huque, Helen Elsey, Kamran Siddiqi, B Stubbs, Najma Siddiqi

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: Co-occurrence of tuberculosis (TB) with other chronic conditions (TB multimorbidity) increases complexity of management and adversely affects health outcomes. We aimed to map the prevalence of the co-occurrence of one or more chronic conditions in people with TB and associated health risks by systematically reviewing previously published systematic reviews.

DESIGN: Systematic review of systematic reviews (meta-review).

SETTING: Low-income and middle-income countries (LMICs).

PAPERS: We searched in Medline, Embase, PsycINFO, Social Sciences Citation Index, Science Citation Index, Emerging Sources Citation Index and Conference Proceedings Citation Index, and the WHO Global Index Medicus from inception to 23 October 2020, contacted authors and reviewed reference lists. Pairs of independent reviewers screened titles, abstracts and full texts, extracted data and assessed the included reviews' quality (AMSTAR2). We included systematic reviews reporting data for people in LMICs with TB multimorbidity and synthesised them narratively. We excluded reviews focused on children or specific subgroups (eg, incarcerated people).

PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence or risk of TB multimorbidity (primary); any measure of burden of disease (secondary).

RESULTS: From the 7557 search results, 54 were included, representing >6 296 000 people with TB. We found that the most prevalent conditions in people with TB were depression (45.19%, 95% CI: 38.04% to 52.55%, 25 studies, 4903 participants, I2=96.28%, high quality), HIV (31.81%, 95% CI: 27.83% to 36.07%, 68 studies, 62 696 participants, I2=98%, high quality) and diabetes mellitus (17.7%, 95% CI: 15.1% to 20.0.5%, 48 studies, 48,036 participants, I2=98.3%, critically low quality).

CONCLUSIONS: We identified several chronic conditions that co-occur in a significant proportion of people with TB. Although limited by varying quality and gaps in the literature, this first meta-review of TB multimorbidity highlights the magnitude of additional ill health burden due to chronic conditions on people with TB.

PROSPERO REGISTRATION NUMBER: CRD42020209012.

Original language	English
Article number	e060906
Number of pages	13
Journal	BMJ Open
Volume	12
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2022-060906 https://doi.org/10.1136/bmjopen-2022-060906
Publication status	Published - 29 Sept 2022

Bibliographical note

Keywords

Child
Developing Countries
Humans
Multimorbidity
Prevalence
Systematic Reviews as Topic
Tuberculosis/epidemiology

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title = "Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries: a meta-review",

abstract = "OBJECTIVES: Co-occurrence of tuberculosis (TB) with other chronic conditions (TB multimorbidity) increases complexity of management and adversely affects health outcomes. We aimed to map the prevalence of the co-occurrence of one or more chronic conditions in people with TB and associated health risks by systematically reviewing previously published systematic reviews.DESIGN: Systematic review of systematic reviews (meta-review).SETTING: Low-income and middle-income countries (LMICs).PAPERS: We searched in Medline, Embase, PsycINFO, Social Sciences Citation Index, Science Citation Index, Emerging Sources Citation Index and Conference Proceedings Citation Index, and the WHO Global Index Medicus from inception to 23 October 2020, contacted authors and reviewed reference lists. Pairs of independent reviewers screened titles, abstracts and full texts, extracted data and assessed the included reviews' quality (AMSTAR2). We included systematic reviews reporting data for people in LMICs with TB multimorbidity and synthesised them narratively. We excluded reviews focused on children or specific subgroups (eg, incarcerated people).PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence or risk of TB multimorbidity (primary); any measure of burden of disease (secondary).RESULTS: From the 7557 search results, 54 were included, representing >6 296 000 people with TB. We found that the most prevalent conditions in people with TB were depression (45.19%, 95% CI: 38.04% to 52.55%, 25 studies, 4903 participants, I2=96.28%, high quality), HIV (31.81%, 95% CI: 27.83% to 36.07%, 68 studies, 62 696 participants, I2=98%, high quality) and diabetes mellitus (17.7%, 95% CI: 15.1% to 20.0.5%, 48 studies, 48,036 participants, I2=98.3%, critically low quality).CONCLUSIONS: We identified several chronic conditions that co-occur in a significant proportion of people with TB. Although limited by varying quality and gaps in the literature, this first meta-review of TB multimorbidity highlights the magnitude of additional ill health burden due to chronic conditions on people with TB.PROSPERO REGISTRATION NUMBER: CRD42020209012.",

keywords = "Child, Developing Countries, Humans, Multimorbidity, Prevalence, Systematic Reviews as Topic, Tuberculosis/epidemiology",

author = "Alexander Jarde and Eugenia Romano and Saima Afaq and Asma Elsony and Yan Lin and Rumana Huque and Helen Elsey and Kamran Siddiqi and B Stubbs and Najma Siddiqi",

note = "{\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.",

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T1 - Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries

T2 - a meta-review

AU - Jarde, Alexander

AU - Romano, Eugenia

AU - Afaq, Saima

AU - Elsony, Asma

AU - Lin, Yan

AU - Huque, Rumana

AU - Elsey, Helen

AU - Siddiqi, Kamran

AU - Stubbs, B

AU - Siddiqi, Najma

N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

PY - 2022/9/29

Y1 - 2022/9/29

N2 - OBJECTIVES: Co-occurrence of tuberculosis (TB) with other chronic conditions (TB multimorbidity) increases complexity of management and adversely affects health outcomes. We aimed to map the prevalence of the co-occurrence of one or more chronic conditions in people with TB and associated health risks by systematically reviewing previously published systematic reviews.DESIGN: Systematic review of systematic reviews (meta-review).SETTING: Low-income and middle-income countries (LMICs).PAPERS: We searched in Medline, Embase, PsycINFO, Social Sciences Citation Index, Science Citation Index, Emerging Sources Citation Index and Conference Proceedings Citation Index, and the WHO Global Index Medicus from inception to 23 October 2020, contacted authors and reviewed reference lists. Pairs of independent reviewers screened titles, abstracts and full texts, extracted data and assessed the included reviews' quality (AMSTAR2). We included systematic reviews reporting data for people in LMICs with TB multimorbidity and synthesised them narratively. We excluded reviews focused on children or specific subgroups (eg, incarcerated people).PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence or risk of TB multimorbidity (primary); any measure of burden of disease (secondary).RESULTS: From the 7557 search results, 54 were included, representing >6 296 000 people with TB. We found that the most prevalent conditions in people with TB were depression (45.19%, 95% CI: 38.04% to 52.55%, 25 studies, 4903 participants, I2=96.28%, high quality), HIV (31.81%, 95% CI: 27.83% to 36.07%, 68 studies, 62 696 participants, I2=98%, high quality) and diabetes mellitus (17.7%, 95% CI: 15.1% to 20.0.5%, 48 studies, 48,036 participants, I2=98.3%, critically low quality).CONCLUSIONS: We identified several chronic conditions that co-occur in a significant proportion of people with TB. Although limited by varying quality and gaps in the literature, this first meta-review of TB multimorbidity highlights the magnitude of additional ill health burden due to chronic conditions on people with TB.PROSPERO REGISTRATION NUMBER: CRD42020209012.

AB - OBJECTIVES: Co-occurrence of tuberculosis (TB) with other chronic conditions (TB multimorbidity) increases complexity of management and adversely affects health outcomes. We aimed to map the prevalence of the co-occurrence of one or more chronic conditions in people with TB and associated health risks by systematically reviewing previously published systematic reviews.DESIGN: Systematic review of systematic reviews (meta-review).SETTING: Low-income and middle-income countries (LMICs).PAPERS: We searched in Medline, Embase, PsycINFO, Social Sciences Citation Index, Science Citation Index, Emerging Sources Citation Index and Conference Proceedings Citation Index, and the WHO Global Index Medicus from inception to 23 October 2020, contacted authors and reviewed reference lists. Pairs of independent reviewers screened titles, abstracts and full texts, extracted data and assessed the included reviews' quality (AMSTAR2). We included systematic reviews reporting data for people in LMICs with TB multimorbidity and synthesised them narratively. We excluded reviews focused on children or specific subgroups (eg, incarcerated people).PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence or risk of TB multimorbidity (primary); any measure of burden of disease (secondary).RESULTS: From the 7557 search results, 54 were included, representing >6 296 000 people with TB. We found that the most prevalent conditions in people with TB were depression (45.19%, 95% CI: 38.04% to 52.55%, 25 studies, 4903 participants, I2=96.28%, high quality), HIV (31.81%, 95% CI: 27.83% to 36.07%, 68 studies, 62 696 participants, I2=98%, high quality) and diabetes mellitus (17.7%, 95% CI: 15.1% to 20.0.5%, 48 studies, 48,036 participants, I2=98.3%, critically low quality).CONCLUSIONS: We identified several chronic conditions that co-occur in a significant proportion of people with TB. Although limited by varying quality and gaps in the literature, this first meta-review of TB multimorbidity highlights the magnitude of additional ill health burden due to chronic conditions on people with TB.PROSPERO REGISTRATION NUMBER: CRD42020209012.

KW - Child

KW - Developing Countries

KW - Humans

KW - Multimorbidity

KW - Prevalence

KW - Systematic Reviews as Topic

KW - Tuberculosis/epidemiology

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DO - 10.1136/bmjopen-2022-060906

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C2 - 36175100

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SN - 2044-6055

VL - 12

JO - BMJ Open

JF - BMJ Open

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M1 - e060906

ER -

Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries: a meta-review

Abstract

Bibliographical note

Keywords

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