Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

Background: Tuberculosis (TB) is a leading cause of mortality in low-and middle-income countries (LMICs). TB multimorbidity (TB & >1 non-communicable diseases (NCDs)) is common, but data is sparse. We investigated the patterns and burden TB multimorbidity in adults across 48 LMICs. Methods: Cross-sectional, community-based data including adults from 21 low-income countries (n=105,286) and 27 middle-income countries (n=137,666) were utilized from the World Health Survey. Nine NCDs (i.e., angina, arthritis, asthma, diabetes, depression, edentulism, hearing problem, schizophrenia and visual impairment) and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Results: Eight out of 9 NCDs (all except visual impairment) were associated with TB (OR ranging from 1.38-4.0). Prevalence of TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95%CI=2.14-3.22), 4.71 (95%CI=3.67-6.11), 6.96 (95%CI=4.95-9.87), 10.59 (7.10-15.80), and 19.89 (95%CI=11.13-35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs with three times higher than controls and a third of the YLDs were attributable to NCDs. Conclusion: People with TB are at substantially greater risk of multimorbid NCDs compared to controls. People with TB and multimorbid NCDs experience considerable increased YLDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed. Funding Statement: This research was supported by the Medical Research Council (Grant Reference: MC_PC_MR/T037806/1 and in part by the National Institute of Health Research using Official Development Assistance (ODA) funding (Grant: 17/63/130: NIHR Global Health Research Group: Improving Outcomes in Mental and Physical Multimorbidity and Developing Research Capacity (IMPACT) in South Asia at the University of York). Declaration of Interests: All authors declare no conflict of interest. Ethics Approval Statement: Ethical approval for the survey was provided by ethical boards at each study site. All participants gave their informed consent.