Trends in Incidence and Mortality of Tuberculosis in India over past three decades: A Joinpoint and Age-Period- Cohort Analysis
BackgroundThe morbidity and mortality burden of tuberculosis has been a major public health challenge in India. Despite various commitments to end the global TB epidemic, India has the highest burden of TB and MDR-TB. To accelerate progress towards the goal of ending TB by 2025, it is imperative to outline the incidence and trend of tuberculosis in India. This study provides the trends in the burden of TB in India, along with age, period and cohort effect of TB. MethodsWe have extracted the TB
... ncidence and mortality estimates from GBD database over the period 1990 to 2019. Joinpoint regression was used to determine the magnitude of time trends in incidence and mortality rates of Tuberculosis by calculating the average annual percent change (AAPC) and its 95% confidence interval (CI). We have analyzed the tuberculosis incidence and mortality trends in India to distinguish age, period and cohort effects by using age-period-cohort (APC) model.ResultsThere has been a decline in age standardized incidence rate in the period 1990-2019. Results from the APC table showed that the incidence and mortality due to tuberculosis in India decreased with the recent cohort. The period RRs of incidence had a downward trend in India in the period 1990-2019. Age standardized incidence and mortality rates of tuberculosis was found higher among males. The period RRs of incidence had a downward trend. Findings show that incidence and mortality were higher in older ages. The cohort effect on the incidence of tuberculosis was found higher among 1990-94 birth cohorts than in the later birth cohorts 2010-14. Wald test results demonstrated that the cohort and period RRs for both sexes and the net drift and local drifts for tuberculosis incidence and mortality were statistically significant.ConclusionHigher incidence and mortality in the older age groups is attributed to poor nutrition and socio-economic status. Improvement in India's public health facility and strategic programs aimed at eliminating tuberculosis might be the reason behind declining RRs in India. The decline in the cohort RRs signifies the effective measures taken to reduce the burden of tuberculosis in the country.