Disability-Adjust Life Years Lost Due to Adult Pulmonary Tuberculosis in Tarrant County, 2005-2006: An Analysis of the Role of Post-Tuberculosis Impairment

Jotam Garaimunashe Pasipanodya M.D., M.H.S.M., University of North Texas Health Science Center at Fort Worth


Pasipaodya, Jotam G. Disability-Adjusted Life Years lost due to adult pulmonary tuberculosis in Tarrant County, 2005-2006: An analysis of the role of post tuberculosis impairment. Doctor of Public Health (Health Management and Policy), May 2008. 145 pages, 18 tables, 11 illustrations, 135 references. Pulmonary impairment after tuberculosis treatment (PIAT) is not yet incorporated in assessing burden of tuberculosis. Previous global and national TB burden estimates therefore dis not fully reflect the consequences of surviving tuberculosis disease. This study was conducted to assess burden of TB in Tarrant County, Texas, using Disability-Adjusted Life Years (DALY). DALY is a composite measurement of premature mortality and disability that equates years of healthy life lost. DALY, stratified by gender and race were calculated for 118 adult TB subjects seen between July 2005 and October 2006. Years of Life Lost (YLL) were calculated from the difference between standard life expectancy and age at death from TB, summed across county populations. Years Lived with Disability (YLD) were derived from and gender-specific disease incidence weight-adjusted for impairment levels; using disability weights obtained from literature. Three percent discount rate per year was used. One hundred and eighteen subjects lost 444.25 DALY during the study period. Years of life lost due to premature mortality (YLL) contributed 159.62 (36%) and years of life lived with disability (YLD) contributed majority of total DALY. Pulmonary impairment after tuberculosis (YLD PIAT) contributed 234.6% (53%), while YLD Acute contributed only 50.04 (11%) of total DALYS. Contrary to previous estimates, disability contributes more than mortality to TB burden in areas with low TB adult and child mortality. PIAT contributes significantly to TB burden, but was previously unrecognized. These findings suggest that the greatest health savings will be achieved through strategies to prevent tuberculosis from developing rather than strategies to shorten treatment once it has developed.