Background: Individuals surviving TB disease may experience chronic sequelae that reduce survival and quality-of-life. These post-TB sequalae are not generally considered in estimates of the health impact of TB disease. We estimated reductions in life expectancy and quality-adjusted life expectancy for individuals developing TB disease in the United States, including post-TB sequelae. Methods: We extracted national surveillance data on individuals diagnosed with TB during 2015-2019, including demographics, vital status at diagnosis, treatment duration, treatment outcome, and co-prevalent conditions. Using a mathematical model we simulated life expectancy and quality-adjusted life-years (QALYs) for the TB cohort, as compared to a no-TB counterfactual. We disaggregated results to report the proportion due to post-TB sequelae, and stratified outcomes by age, sex, and race. Findings: Estimated life expectancy after TB diagnosis was 30.3 (95% uncertainty interval: 29.9, 30.7) years for the TB cohort versus 32.3 (31.9, 32.7) without TB, a difference of 2.03 (1.84, 2.21) years and 1.93 (1.69, 2.18) QALYs. Life-years lost were greatest for 65-74-year-olds versus other age groups, for men versus women, and for American Indian or Alaska Native individuals versus persons from other race/ethnicities. Overall, 41% (35, 46) of life-years and 48% (42, 54) of QALYs lost were estimated to result from post-TB sequelae. Interpretation: In the United States, a substantial fraction of the life-years and QALYs lost from TB are attributable to post-TB sequelae. Evidence is needed on approaches to prevent and repair post-TB lung damage, in the context of frequent co-prevalent health conditions. Funding: CDC.

This study was funded by the U.S. Centers for Disease Control and Prevention.

U.S. Centers for Disease Control and Prevention

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board (IRB) of the Harvard T.H. Chan School of Public Health determined that this submission is not human subjects research as defined by DHHS regulations or FDA regulations (IRB22-1328).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

National TB Surveillance System data contain information abstracted from the national tuberculosis case report form called the Report of Verified Case of Tuberculosis (RVCT) (OMB No. 0920-0728). These data have been reported voluntarily to CDC by state and local health departments and are protected under the Assurance of Confidentiality (Sections 306 and 308(d) of the Public Health Service Act, 42 U.S.C. 242k and 242m(d)), which prevents disclosure of any information that could be used to directly or indirectly identify patients. For more information, see the CDC/ATSDR Policy on Releasing and Sharing Data (at http://www.cdc.gov/maso/Policy/ReleasingData.pdf). A limited dataset is available at http://wonder.cdc.gov/tb.html. Researchers seeking additional National TB Surveillance System data may request access through the National Center for Health Statistics Research Data Centers (https://www.cdc.gov/rdc/b1datatype/tuberculosis.htm).

http://wonder.cdc.gov/tb.html