Sex distribution in tuberculosis disease in children, adolescents, and adults in a low-incidence country: a retrospective population-based cohort study.

Abstract

Aim: Globally, tuberculosis incidence shows notable sex disparity, with higher rates observed in males. While this pattern is well documented in adults from high-incidence countries, the influence of sex on tuberculosis incidence in children and adolescents, particularly in low-incidence settings, remains unclear. This study investigated sex-specific tuberculosis incidence rates across all age groups, focusing on adolescents, in a low-incidence country.

Methods:  In this retrospective cohort study, data from the Swiss Federal Office of Public Health (FOPH) tuberculosis database, which centrally consolidates mandatory notifications from physicians and laboratories across Switzerland, were analysed from 2000 to 2021. Tuberculosis incidence rates and male-to-female ratios were calculated and stratified by sex and age. Adolescence was divided into early (10-14 years) and late (15-19 years) stages for detailed analysis.

Results: Over 22 years, the average tuberculosis incidence in Switzerland was 6.78 per 100,000 population, with an overall male-to-female ratio of 1:0.75 (p <0.001). Among the 11,872 notified cases, 832 occurred in adolescents, yielding an incidence rate of 4.39 per 100,000. In late adolescence, males had a significantly higher tuberculosis incidence rate (5.73 per 100,000) than females (2.97 per 100,000, p <0.001), resulting in a male-to-female ratio of 1:0.5. Additionally, data on asylum seekers revealed nearly twice as many males as females arriving in Switzerland in late adolescence.

Conclusions: This study reveals significant sex disparity in tuberculosis incidence in a country with low tuberculosis incidence, with males showing higher rates than females beginning in late adolescence. This discrepancy is likely influenced by the higher influx of male asylum seekers in adolescence.