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The Effect of Multimorbidity on Risk of Developing Post-Tuberculosis Lung Disease (PTLD) in Low- and Middle-Income Countries (LMICs): A Systematic Review and Meta-Analysis
26 Pages Posted: 11 Apr 2025
More...Abstract
Background: Post-tuberculosis lung disease (PTLD), a chronic respiratory syndrome affecting up to 87% of tuberculosis (TB) survivors, is an emerging public health threat in high TB-burden, low- and middle-income countries (LMICs). The prevalence of multimorbidity, defined as two or more co-existing chronic health conditions, is increasing in LMICs but it is unclear whether and how this affects the risk of PTLD.
Methods: This systematic review and meta-analysis explores this question. Medline, EMBASE, Web of Science, Global Health, and Scopus databases up to 7th March 2024 were searched and studies in LMICs assessing PTLD and either a single co-morbidity or multimorbidity and TB were included. Summary data were extracted independently by two reviewers. Random effects meta-analyses were performed where sufficient comparable data were reported. Study protocol was registered with PROSPERO (CRD42024552486).
Findings: 41 papers, from 10,321 screened, were included. No studies analysed multimorbidity. Meta-analysis of 10 out of 24 papers analysing the association between PTLD and HIV status found reduced odds of PTLD in people living with HIV (odds ratio (OR) 0·68, 95% confidence interval (CI) 0·52 to 0·88). 15 papers reported on diabetes and showed inconsistent associations; meta-analysis of three papers yielded an OR of 1·65 (95% CI 0·96 to 2·84). Whether analysed categorically or continuously, decreasing BMI was associated with increased odds of PTLD; undernourished adults had increased odds of abnormal spirometry following TB on meta-analysis of three studies (OR 1·99, 95% CI 1·02 to 3·87). No clear associations were seen with other co-morbidities, but analysis was limited by lack of consistency in PTLD assessment method and small study sizes.
Interpretation: This review has highlighted the need for uniformity in defining and measuring PTLD in research, and for prospective studies which look at associations between multimorbidity and individual co-morbidities and PTLD.
Keywords: Tuberculosis, Multimorbidity, Co-morbidity, Post-tuberculosis lung disease, Non-communicable disease, Human immunodeficiency virus
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