The risk of multidrug or rifampicin-resistance in men versus women with TB.

Men are at an increased risk of Tuberculosis disease compared to women. Several risk factors for multidrug-resistant (MDR) or rifampicin-resistant (RR) TB disease are also more common in men, 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%(86/106) of countries, with an overall random-effects weighted M:F risk ratio of 1.04[95% confidence interval 0.97–1.11]. In 12%(13/106) of countries there was evidence that men were more at risk, while in 7%(7/106) women were more at risk. The risk of having TB that was MDR/RR increased for men compared to women as MDR/RR-TB incidence increased, and was higher for men than women in the Former Soviet Union, where the risk ratio was 1.16[1.06–1.28]. Conversely, the risk increased for women compared to men as GDP increased, and was higher for women than men 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 men as for women. However, men 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 gender-differentiated approach to TB case-finding and care.