Newswise — A recent study led by Boston University School of Public Health (BUSPH) has revealed that incarcerated individuals worldwide had a significantly higher incidence of tuberculosis (TB) compared to the general population in 2019. Published in The Lancet Public Health, the study indicates that out of the 11 million people incarcerated globally, 125,105 individuals developed tuberculosis, resulting in a rate of 1,148 cases per 100,000 persons per year.
Remarkably, nearly half of the tuberculosis cases among incarcerated individuals went undetected. These findings provide the first global and regional estimates of new TB cases within the incarcerated population, which is particularly vulnerable to this life-threatening disease. The combination of high case rates and low detection underscores the urgent need for increased awareness and resources to alleviate the burden of tuberculosis in prisons and other high-risk environments.
Dr. Leonardo Martinez, assistant professor of epidemiology at BUSPH and lead author of the study, emphasizes the neglect and limited access to healthcare services for incarcerated individuals by highlighting that only 53 percent of tuberculosis cases in prisons are diagnosed.
To gain deeper insights into tuberculosis rates within this population, Dr. Martinez and his colleagues collected data from published research and federal officials of various countries. They analyzed TB prevalence and incidence in 193 countries at global, regional, and national levels between 2000 and 2019. The team also calculated the annual tuberculosis case detection rates for each country.
The African region exhibited the highest rate of new TB cases in 2019, with 2,242 cases per 100,000 persons per year. However, the Americas region, primarily driven by Central and South America, reported the highest number of total cases, marking an increase of nearly 90 percent since 2000. In 2019, the countries with the highest number of new tuberculosis cases in prisons were Brazil, Russia, China, the Philippines, and Thailand.
Significantly, the study team discovered that the rates of new tuberculosis cases remained consistently high, ranging between 1,100 and 1,200 cases per 100,000 persons per year from 2012 to 2019.
"This lack of progress suggests that the current tuberculosis control policies in prisons are insufficient to reduce the burden of tuberculosis, necessitating additional interventions and policy implementation," comments Dr. C. Robert Horsburgh, a professor of global health at BUSPH.
Mass incarceration plays a significant role in the transmission of TB, both within and outside of prison facilities. Overcrowding, with some prison cells accommodating up to 30 individuals, leads to the rapid spread of tuberculosis. This transmission can easily extend to the wider community.
Contrary to common belief, incarcerated individuals are a mobile population, and in many countries, their periods of incarceration are brief. Dr. Martinez explains, "People go into prison, then come out, then may go back in again. So, very often, people who develop tuberculosis in prison end up transmitting the disease to many people outside of prison once they are released. Since almost half of the individuals with tuberculosis in prisons go undiagnosed, many remain infectious when they reenter the general community."
The researchers hope that these findings will prompt global and regional health organizations to establish routine monitoring of tuberculosis among incarcerated individuals, similar to the approach taken for other high-risk populations such as individuals with HIV and household contacts. The team believes that their comprehensive compilation of tuberculosis case data, obtained directly from federal officials, national and regional organizations, and non-governmental organizations, demonstrates that information regarding tuberculosis in prisons is accessible and can be obtained by global entities like the World Health Organization.
At present, the research team is collaborating with various health organizations in an effort to revise global guidelines on the management and reduction of tuberculosis in prison settings. This initiative is crucial as the existing guidelines were last updated in 2000.
Dr. Martinez emphasizes that the neglect of this population stems, in part, from the scarcity of data. He expresses hope that these findings will enable stakeholders to comprehend the urgency of the problem and the significant number of incarcerated individuals who develop tuberculosis but remain undiagnosed for prolonged periods. The team aims to use this information as a catalyst to inspire action among stakeholders.
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