The long-term effects of domestic and international tuberculosis service improvements on tuberculosis trends within the USA: a mathematical modelling study.

IF 25.4 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Public Health Pub Date : 2024-08-01 DOI:10.1016/S2468-2667(24)00150-6

Nicolas A Menzies, Nicole A Swartwood, Ted Cohen, Suzanne M Marks, Susan A Maloney, Courtney Chappelle, Jeffrey W Miller, Garrett R Beeler Asay, Anand A Date, C Robert Horsburgh, Joshua A Salomon

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引用次数: 0

Abstract

Background: For settings with low tuberculosis incidence, disease elimination is a long-term goal. We investigated pathways to tuberculosis pre-elimination (incidence <1·0 cases per 100 000 people) and elimination (incidence <0·1 cases per 100 000 people) in the USA, where incidence was estimated at 2·9 per 100 000 people in 2023.

Methods: Using a mathematical modelling framework, we simulated how US tuberculosis incidence could be affected by changes in tuberculosis services in the countries of origin for future migrants to the USA, as well as changes in tuberculosis services inside the USA. To do so, we used a linked set of transmission dynamic models, calibrated to demographic and epidemiological data for each setting. We constructed intervention scenarios representing improvements in tuberculosis services internationally and within the USA, individually and in combination, plus a base-case scenario representing continuation of current services. We simulated health and economic outcomes until 2100, using a Bayesian approach to quantify uncertainty in these outcomes.

Findings: Under the base-case scenario, US tuberculosis incidence was projected to decline to 1·8 cases per 100 000 (95% uncertainty interval [UI] 1·5-2·1) in the total population by 2050. Intervention scenarios produced substantial reductions in tuberculosis incidence, with the combination of all domestic and international interventions projected to achieve pre-elimination by 2033 (95% UI 2031-2037). Compared with the base-case scenario, this combination of interventions could avert 101 000 tuberculosis cases (95% UI 84 000-120 000) and 13 300 tuberculosis deaths (95% UI 10 500-16 300) in the USA from 2025 to 2050. Tuberculosis elimination was not projected before 2100.

Interpretation: Strengthening tuberculosis services domestically, promoting the development of more effective technologies and interventions, and supporting tuberculosis programmes in countries with a high tuberculosis burden are key strategies for accelerating progress towards tuberculosis elimination in the USA.

Funding: US Centers for Disease Control and Prevention.

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国内和国际结核病服务改进对美国结核病趋势的长期影响：数学模型研究。

背景：在结核病发病率较低的地区，消灭结核病是一个长期目标。我们调查了肺结核消灭前（发病率方法）的途径：通过数学模型框架，我们模拟了美国结核病发病率如何受到未来移民到美国的原籍国结核病服务变化以及美国国内结核病服务变化的影响。为此，我们使用了一套关联的传播动态模型，并根据每种环境下的人口和流行病学数据进行了校准。我们构建了干预方案，分别代表了国际和美国国内结核病服务的改进（单独或组合），以及代表继续提供当前服务的基础方案。我们模拟了 2100 年前的健康和经济结果，并使用贝叶斯方法量化了这些结果的不确定性：根据基础方案，预计到 2050 年，美国结核病发病率将下降到每 10 万人 1-8 例（95% 不确定区间 [UI] 1-5-2-1）。干预方案大幅降低了结核病发病率，预计到 2033 年（95% UI 为 2031-2037 年），所有国内和国际干预措施将达到消灭前水平。与基础方案相比，从 2025 年到 2050 年，这种干预措施组合可使美国避免 101 000 例结核病病例（95% UI 84 000-120 000）和 13 300 例结核病死亡（95% UI 10 500-16 300）。预计在 2100 年前不会消灭结核病：加强国内结核病防治服务、促进开发更有效的技术和干预措施、支持结核病高负担国家的结核病防治计划，是美国加快消除结核病进程的关键战略：美国疾病控制和预防中心。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Public Health Medicine-Public Health, Environmental and Occupational Health

CiteScore

55.60

自引率

0.80%

发文量

305

审稿时长

8 weeks

期刊介绍： The Lancet Public Health is committed to tackling the most pressing issues across all aspects of public health. We have a strong commitment to using science to improve health equity and social justice. In line with the values and vision of The Lancet, we take a broad and inclusive approach to public health and are interested in interdisciplinary research. We publish a range of content types that can advance public health policies and outcomes. These include Articles, Review, Comment, and Correspondence. Learn more about the types of papers we publish.