I have an unpopular view on sex and gender and tuberculosis. Indulge me for a moment. Around the globe, men have *double* the incidence and prevalence of tuberculosis. *Both* sex and gender must be causes for this.
New research with a team that includes Myanmar health scientists outlines the issue of poor treatment outcomes for males in Taiwan.
You can download the preprint https://www.medrxiv.org/content/10.1101/2021.04.26.21256155v1.full.pdf
Some people will be angry at me for writing this. Too bad.
Jamie
++++++++++++++++++
Sex differences in TB treatment outcomes: Retrospective cohort study and meta-analysis
Vignesh Chidambaram, Nyan Lynn Tun, Marie Gilbert Majella, Jennie Ruelas Castillo, Samuel K. Ayeh, Amudha Kumar, Pranita Neupane, Ranjith Kumar Sivakumar, Ei Phyo Win, Enoch J. Abbey, Siqing Wang, Alyssa Zimmerman, Jaime Blanck, Akshay Gupte, Jann-Yuan Wang, Petros C. Karakousis
https://doi.org/10.1101/2021.04.26.21256155
Abstract
Rationale
Although the incidence of tuberculosis (TB) is higher in males compared to females, the relationship of sex with TB treatment outcomes has not been adequately studied.
Objectives and Methods
We performed a retrospective cohort study and a systematic review and meta-analysis of observational studies during the last 10 years to assess the sex differences in clinical and microbiological outcomes in tuberculosis.
Measurements and Main Results
In our cohort of 2,894 patients with drug-susceptible pulmonary TB (1,975 males and 919 females), males had higher adjusted hazards of mortality due to all causes (HR 1·43,95%CI 1.03-1.98) and infections (HR 1.70, 95%CI 1.09-2.64) at 9 months and higher adjusted odds ratio for sputum culture (OR 1.56,95%CI 1.05-2.33) and similar odds ratio for smear positivity (OR 1.27, 0.71-2.27) at 2 months compared to females. Among 7896 articles retrieved, 398 articles were included in our systematic review with a total of 3,957,216 patients. The odds of all-cause mortality was higher in males compared to females in the pooled unadjusted (OR 1.26, 95%CI 1.19-1.34) and adjusted (OR 1.31, 95%CI 1.18-1.45) analyses. Relative to females, males had higher pooled odds of sputum culture (OR 1.44,95% CI 1.14-1.81) and sputum smear (OR 1.58,95%CI 1.41-1.77) positivity at the end of the intensive phase, and upon completion of treatment.
Conclusions During TB treatment, males have higher all-cause-, infection- and TB-related mortality, as well as higher rates of sputum smear and culture positivity, both after the intensive phase and at the completion of TB treatment, after adjusting for confounding factors.
https://www.medrxiv.org/content/10.1101/2021.04.26.21256155v1
