In the first global assessment of tuberculosis (TB) among incarcerated people, a new study has found consistently high TB case rates and low case detection in prisons. According to the study published in ‘The Lancet Public Health, health organisations need to increase efforts to reduce the spread of the disease among this high-risk population.
A Professor of Global Health at the Boston University School of Public Health (BUSPH), Dr. C. Robert Horsburgh said the current TB control policy in prisons is insufficient to decrease the TB burden, saying that supplementary interventions and policy implementation are needed.”
In 2019, incarcerated people across the globe developed TB at nearly 10 times the rate of people in the general population, according to a new study led by Boston University School of Public Health (BUSPH).
The study found that 125,105 of the 11 million people incarcerated worldwide developed TB in 2019, a rate of 1,148 cases per 100,000 persons per year. Despite this high case rate, nearly half of TB cases among incarcerated people were not detected.
The findings reveal the first global and regional estimates of new TB cases among incarcerated people, a population at high risk of developing this life-threatening disease. Collectively, the high case rate and low detection underscore the need for greater awareness and resources to reduce the burden of TB in prisons and other high-risk settings.
“Our study showed that only 53 per cent of people that develop TB in prisons are diagnosed, which suggests that incarcerated people are neglected and have minimal health care services to diagnose TB,” stated study lead and corresponding author Dr. Leonardo Martinez, assistant professor of epidemiology at BUSPH.
To better understand TB rates among this population, Dr. Martinez and colleagues acquired data from published research and from countries’ federal officials to analyse TB prevalence and incidence in 193 countries at the country, regional, and global level between 2000–2019.
The team also calculated TB case detection rates per year in each country for 193 countries. The African region had the highest rate of new TB cases in 2019, at 2,242 cases per 100,000 persons per year, but the Americas region—largely driven by Central and South America—had the greatest number of total cases, which increased nearly 90 per cent since 2000.
The countries with the highest number of new cases in prisons in 2019 were Brazil, Russia, China, the Philippines, and Thailand. Importantly, the team found that new TB case rates remained consistently between 1,100 and 1,200 cases per 100,000 persons per year from 2012–2019.
“This stagnation suggests that current TB control policy in prisons is insufficient to decrease the TB burden and that supplementary interventions and policy implementation are needed,” said Horsburgh. Mass incarceration is one major driver of TB transmission—both inside and outside of prisons.
Overcrowding, where some prison cells contain up to 30 people, causes TB to “spread like wildfire,” Dr. Martinez said, and this transmission can spill over easily into the community.