Abstract
Males are at an increased risk of tuberculosis (TB) disease compared to females. Additionally, several risk factors for multidrug-resistant (MDR) or rifampicin-resistant (RR) TB disease are more common in males, hence male TB patients may have a higher relative risk of MDR/RR-TB than female TB patients.
We used sex-disaggregated data of TB patients reported to the World Health Organization for 106 countries to calculate male-to-female (M:F) risk ratios of having MDR/RR-TB.
There was no evidence of either sex being more at risk of MDR/RR-TB in 81% (86 out of 106) of countries, with an overall random-effects weighted M:F risk ratio of 1.04 (95% CI 0.97–1.11). In 12% (13 out of 106) of countries there was evidence that males were more at risk, while in 7% (seven out of 106), females were more at risk. The risk of having TB that was MDR/RR increased for males compared to females as MDR/RR-TB incidence increased, and was higher for males than females in the former Soviet Union, where the risk ratio was 1.16 (1.06–1.28). Conversely, the risk increased for females compared to males as gross domestic product purchase power parity increased, and was higher for females than males in countries where the majority of TB burden was found in the foreign-born population, where the risk ratio was 0.84 (0.75–0.94).
In general, the risk of MDR/RR-TB, among those with TB, is the same for males as for females. However, males in higher MDR/RR-TB burden countries, particularly the former Soviet Union, face an increased risk that their infection is MDR/RR-TB, highlighting the need for a sex-differentiated approach to TB case-finding and care.
Abstract
Globally, the risk of drug resistance among those with TB is the same for males as for females. However, local differences in high-burden risk groups lead to a need for a sex-differentiated approach to TB case-finding and care in some settings. https://bit.ly/2Z7nJon
Footnotes
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Author contributions: C.F. McQuaid and K.C. Horton conceived and designed the study. C.F. McQuaid performed all the data analysis and wrote a first draft of the article. C.F. McQuaid, K.C. Horton, A.S. Dean, G.M. Knight and R.G. White designed the methodology and critiqued the results. All authors contributed to editing the final draft.
Conflict of interest: C.F. McQuaid has nothing to disclose.
Conflict of interest: K.C. Horton has nothing to disclose.
Conflict of interest: A.S. Dean has nothing to disclose.
Conflict of interest: G.M. Knight has nothing to disclose.
Conflict of interest: R.G. White has nothing to disclose.
Support statement: C.F. McQuaid was funded by the Bill and Melinda Gates Foundation (TB MAC OPP1135288). G.M. Knight was supported by a fellowship from the UK Medical Research Council (MRC) (MR/P014658/1). R.G. White was funded by the UK MRC and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement that is also part of the EDCTP2 programme supported by the European Union (MR/P002404/1), the Bill and Melinda Gates Foundation (TB Modelling and Analysis Consortium: OPP1084276/OPP1135288, CORTIS: OPP1137034/OPP1151915, Vaccines: OPP1160830), UNITAID (4214-LSHTM-Sept15; PO 8477-0-600), and ESRC (ES/P008011/1).
- Received March 10, 2020.
- Accepted May 7, 2020.
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