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Home / The International Journal of Tuberculosis and Lung Disease, Volume 27, Number 9

Survival of people with untreated TB: effects of time, geography and setting

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BACKGROUND: An estimated 40% of people who developed TB in 2021 were not diagnosed or treated. Pre-chemotherapy era data are a rich resource on survival of people with untreated TB. We aimed to identify heterogeneities in these data to inform their more precise use.

METHODS: We extracted survival data from pre-chemotherapy era papers reporting TB-specific mortality and/or natural recovery data. We used Bayesian parametric survival analysis to model the survival distribution, stratifying by geography (North America vs. Europe), time (pre-1930 vs. post-1930), and setting (sanitoria vs. non-sanitoria).

RESULTS: We found 12 studies with TB-specific mortality data. Ten-year survival was 69% in North America (95% CI 54–81) and 36% in Europe (95% CI 10–71). Only 38% (95% CI 18–63) of non-sanitorium individuals survived to 10 years compared to 69% (95% CI 41–87) of sanitoria/hospitalized patients. There were no significant differences between people diagnosed pre-1930 and post-1930 (5-year survival pre-1930: 65%, 95% CI 44–88 vs. post-1930: 72%, 95% CI 41–94).

CONCLUSIONS: Mortality and natural recovery risks vary substantially by location and setting. These heterogeneities need to be considered when using pre-chemotherapy data to make inferences about expected survival of people with undiagnosed TB.

Keywords: Bayesian analysis; mortality; natural recovery; self-cure; survival analysis

Document Type: Research Article

Affiliations: 1: Departments of Epidemiology, and 2: Departments of Biostatistics, Boston University School of Public Health, Boston, MA 3: Section of Infectious Diseases, Boston Medical Center, Boston, MA, Boston University School of Medicine, Boston, MA, USA 4: Departments of Epidemiology, and, Departments of Biostatistics, Boston University School of Public Health, Boston, MA 5: Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway, Center of Infectious Disease Dynamics, Pennsylvania State University, Philadelphia, PA 6: Department of Global Health, Boston University School of Public Health, Boston, MA USA

Publication date: September 1, 2023

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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