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Assessing Tuberculosis Case Fatality Ratio: A Meta-Analysis

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  • Masja Straetemans
  • Philippe Glaziou
  • Ana L Bierrenbach
  • Charalambos Sismanidis
  • Marieke J van der Werf

Abstract

Background: Recently, the tuberculosis (TB) Task Force Impact Measurement acknowledged the need to review the assumptions underlying the TB mortality estimates published annually by the World Health Organization (WHO). TB mortality is indirectly measured by multiplying estimated TB incidence with estimated case fatality ratio (CFR). We conducted a meta-analysis to estimate the TB case fatality ratio in TB patients having initiated TB treatment. Methods: We searched for eligible studies in the PubMed and Embase databases through March 4th 2011 and by reference listing of relevant review articles. Main analyses included the estimation of the pooled percentages of: a) TB patients dying due to TB after having initiated TB treatment and b) TB patients dying during TB treatment. Pooled percentages were estimated using random effects regression models on the combined patient population from all studies. Main Results: We identified 69 relevant studies of which 22 provided data on mortality due to TB and 59 provided data on mortality during TB treatment. Among HIV infected persons the pooled percentage of TB patients dying due to TB was 9.2% (95% Confidence Interval (CI): 3.7%–14.7%) and among HIV uninfected persons 3.0% (95% CI: −1.2%–7.4%) based on the results of eight and three studies respectively providing data for this analyses. The pooled percentage of TB patients dying during TB treatment was 18.8% (95% CI: 14.8%–22.8%) among HIV infected patients and 3.5% (95% CI: 2.0%–4.92%) among HIV uninfected patients based on the results of 27 and 19 studies respectively. Conclusion: The results of the literature review are useful in generating prior distributions of CFR in countries with vital registration systems and have contributed towards revised estimates of TB mortality This literature review did not provide us with all data needed for a valid estimation of TB CFR in TB patients initiating TB treatment.

Suggested Citation

  • Masja Straetemans & Philippe Glaziou & Ana L Bierrenbach & Charalambos Sismanidis & Marieke J van der Werf, 2011. "Assessing Tuberculosis Case Fatality Ratio: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 6(6), pages 1-1, June.
    • Handle: RePEc:plo:pone00:0020755
    DOI: 10.1371/journal.pone.0020755
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    References listed on IDEAS

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    1. Masja Straetemans & Ana L Bierrenbach & Nico Nagelkerke & Philippe Glaziou & Marieke J van der Werf, 2010. "The Effect of Tuberculosis on Mortality in HIV Positive People: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 5(12), pages 1-10, December.
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    Cited by:

    1. Felix Chopra & Armin Falk & Thomas Graeber, 2024. "Intertemporal Altruism," American Economic Journal: Microeconomics, American Economic Association, vol. 16(1), pages 329-357, February.
    2. Tae Gun Kang & Kee Woong Kwon & Kyungsoo Kim & Insuk Lee & Myeong Joon Kim & Sang-Jun Ha & Sung Jae Shin, 2022. "Viral coinfection promotes tuberculosis immunopathogenesis by type I IFN signaling-dependent impediment of Th1 cell pulmonary influx," Nature Communications, Nature, vol. 13(1), pages 1-19, December.
    3. Roland Bénabou & Armin Falk & Luca Henkel & Jean Tirole, 2020. "Eliciting Moral Preferences: Theory and Experiment," Working Papers 2020-17, Princeton University. Economics Department..
    4. Musharraf Cyan & Michael Price & Mark Rider, 2017. "A Health Literacy RCT toward Improvement of Programmatic Outcomes of Tuberculosis Control in the Tribal Areas of Pakistan Governance Support Program Post-Crisis," International Center for Public Policy Working Paper Series, at AYSPS, GSU paper1711, International Center for Public Policy, Andrew Young School of Policy Studies, Georgia State University.
    5. Anna Odone & Silvia Amadasi & Richard G White & Theodore Cohen & Alison D Grant & Rein M G J Houben, 2014. "The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-12, November.

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