In total, up to 195,449 children (aged under 15), 1,126,133 adults (aged 15 to 64) and 235,402 older people (aged 65 and over) were estimated to have missed or delayed TB diagnosis in 2020 as a result of the COVID-19 holidays. These numbers include 511,546 women and 863,916 men. The call for action follows the results of a new study exploring potential age and gender disparities in the impact of disruptions caused by the COVID-19 pandemic on access to diagnoses of this deadly disease. The team – including researchers from the London School of Hygiene & Tropical Medicine (LSHTM) – modeled trends in the reporting of TB cases to the World Health Organization (WHO) for 45 high-burden countries between 2013 and 2019. The projections for 2020 using these models were then compared to actual observations in the same year. Although the study found no evidence of systemic disparity in risk by age or gender on a global scale, when disaggregated by country, disparities related to the environment were revealed.
For example, in more than half of the countries (57.1%) analyzed, children were at greater risk of delayed or missed TB diagnosis due to COVID-19 than adults, with children in WHO Eastern Mediterranean regions (ie Pakistan and Somalia) and Europe (ie Tajikistan and Ukraine) were found to be disproportionately affected. Similarly, higher risk rates were also revealed for older people compared to adults, specifically in over two-thirds of countries (70.1%), including WHO regions in the Western Pacific (such as China and Mongolia) and the Europe (for example, Kazakhstan and Belarus). . In almost half of the countries (45%), gender was predicted to be an important risk factor. Men, for example, were found to be particularly prone to missed or delayed diagnoses in the WHO region of the Americas (ie, Peru and Brazil). These results suggest that the pandemic may have resulted in large numbers of people with TB going untreated and unknowingly spreading, with long-term public health implications. Joint lead author Dr Finn McQuaid, from the TB Center and Center for Mathematical Modeling of Infectious Diseases (CMMID) at LSHTM, said: “Our results show that in many countries those who were already facing the greatest difficulties in TB diagnosis and care have suffered worsening access as a result of the pandemic. As we work to recover from and mitigate the impact that COVID-19 has had on people with TB, it is vital that we focus on those most in need; not just out of duty to address these inequities, but to have hope of ending TB ». Despite accounting for the second highest number of deaths from infectious diseases worldwide, TB case detection rates are low with disparities in burden and access to care, particularly for men, older people and children. Until now, research on disruptions in TB care caused by COVID-19 has focused on the overall impact of the pandemic, without considering the impact of potential disparities, such as those related to age or gender. The findings of this study may provide vital guidance as to the main areas that policymakers should target to reduce the impact of the pandemic on the global burden of TB, moving us one step closer to ensuring equitable care for patients. Co-author Dr Katherine Horton, also from the TB Center and CMMID, said: “Population groups whose access to TB diagnosis has been disproportionately affected by the COVID-19 pandemic should be prioritized in coverage campaigns. For example, in settings where children have missed diagnoses, school-based strategies may be useful, while gender-sensitive strategies should be applied in settings where one gender is relatively underdiagnosed.’ He went on to stress that “Programs must also monitor the ongoing impact of the pandemic on these groups to ensure equitable access to TB care so that no one is left behind.”

Article title

Disparities in the impact of COVID-19-related disorders on TB diagnosis by age and gender in 45 high-burden TB countries

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14-Nov-2022 Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases published on EurekAlert! with contributing institutions or to use any information through the EurekAlert system.