Abstract
Rationale: Individuals surviving tuberculosis (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. Objectives: To estimate the TB-attributable 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 with diagnoses of TB from 2015 to 2019, including demographics, vital status at diagnosis, treatment duration, treatment outcome, and coprevalent conditions. Using a mathematical model, we simulated life expectancy and quality-adjusted life-years (QALYs) for the TB cohort compared with a no-TB counterfactual (with the same distributions of age, sex, race/ethnicity, and coprevalent conditions as the TB cohort but without TB-attributable mortality and disutility). We disaggregated results to report the proportions of QALYs and life-years lost from TB due to post-TB sequelae and stratified outcomes by age, sex, and race. Measurements and Main Results: 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) years 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 individuals 65-74 years of age versus other age groups, for men versus women, and for American Indian or Alaska Native individuals versus persons from other races/ethnicities. Overall, 41% (35-46%) of life-years and 48% (42-54%) of QALYs lost were estimated to result from post-TB sequelae. Conclusions: In the United States, a substantial fraction of 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 coprevalent health conditions.