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Forecasting the impact of diabetes mellitus on tuberculosis disease incidence and mortality in India

journal contribution
submitted on 2024-05-27, 08:11 and posted on 2024-05-27, 09:27 authored by Susanne F Awad, Peijue Huangfu, Houssein H Ayoub, Fiona Pearson, Soha R Dargham, Julia A Critchley, Laith J Abu-Raddad


In context of the rapidly expanding diabetes mellitus (DM) epidemic in India and slowly declining tuberculosis (TB) incidence, we aimed to estimate the past, current, and future impact of DM on TB epidemiology.


An age-structured TB-DM dynamical mathematical model was developed and analyzed to assess the DM-on-TB impact. The model was calibrated using a literature review and meta-analyses. The DM-on-TB impact was analyzed using population attributable fraction metrics. Sensitivity analyses were conducted by accommodating less conservative effect sizes for the TB-DM interactions, by factoring the age-dependence of the TB-DM association, and by assuming different TB disease incidence rate trajectories.


In 1990, 11.4% (95% uncertainty interval (UI)=6.3%-14.4%) of new TB disease incident cases were attributed to DM. This proportion increased to 21.9% (95% UI=12.1%-26.4%) in 2017, and 33.3% (95% UI=19.0%-44.1%) in 2050. Similarly, in 1990, 14.5% (95% UI=9.5%- 18.2%) of TB-related deaths were attributed to DM. This proportion increased to 28.9% (95% UI=18.9%-34.1%) in 2017, and 42.8% (95% UI=28.7%-53.1%) in 2050. The largest impacts originated from the effects of DM on TB disease progression and infectiousness. Sensitivity analyses suggested that the impact could be even greater.


The burgeoning DM epidemic is predicted to become a leading driver of TB disease incidence and mortality over the coming decades. By 2050, at least one-third of TB incidence and almost half of TB mortality in India will be attributed to DM. This is likely generalizable to other Asian Pacific countries with similar TB-DM burdens. Targeting the impact of the increasing DM burden on TB control is critical to achieving the goal of TB elimination by 2050.

Other Information

Published in: Journal of Global Health
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Open Access funding provided by the Qatar National Library.



  • English


International Global Health Society

Publication Year

  • 2019

License statement

This Item is licensed under the Creative Commons Attribution 4.0 International License.

Institution affiliated with

  • Hamad Bin Khalifa University
  • College of Health and Life Sciences - HBKU
  • Qatar University
  • College of Arts and Sciences - QU
  • Weill Cornell Medicine - Qatar

Geographic coverage