Background

Prisons are recognised as high-risk environments for tuberculosis, but there has been little systematic investigation of the global and regional incidence and prevalence of tuberculosis, and its determinants, in prisons. We did a systematic review and meta-analysis to assess the incidence and prevalence of tuberculosis in incarcerated populations by geographical region.

Methods

In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Knowledge, and the LILACS electronic database from Jan 1, 1980, to Nov 15, 2020, for cross-sectional and cohort studies reporting the incidence of Mycobacterium tuberculosis infection, incidence of tuberculosis, or prevalence of tuberculosis among incarcerated individuals in all geographical regions. We extracted data from individual studies, and calculated pooled estimates of incidence and prevalence through hierarchical Bayesian meta-regression modelling. We also did subgroup analyses by region. Incidence rate ratios between prisons and the general population were calculated by dividing the incidence of tuberculosis in prisons by WHO estimates of the national population-level incidence.

Findings

We identified 159 relevant studies; 11 investigated the incidence of M tuberculosis infection (n=16 318), 51 investigated the incidence of tuberculosis (n=1 858 323), and 106 investigated the prevalence of tuberculosis (n=6 727 513) in incarcerated populations. The overall pooled incidence of M tuberculosis infection among prisoners was 15·0 (95% credible interval [CrI] 3·8–41·6) per 100 person-years. The incidence of tuberculosis (per 100 000 person-years) among prisoners was highest in studies from the WHO African (2190 [95% CrI 810–4840] cases) and South-East Asia (1550 [240–5300] cases) regions and in South America (970 [460–1860] cases), and lowest in North America (30 [20–50] cases) and the WHO Eastern Mediterranean region (270 [50–880] cases). The prevalence of tuberculosis was greater than 1000 per 100 000 prisoners in all global regions except for North America and the Western Pacific, and highest in the WHO South-East Asia region (1810 [95% CrI 670–4000] cases per 100 000 prisoners). The incidence rate ratio between prisons and the general population was much higher in South America (26·9; 95% CrI 17·1–40·1) than in other regions, but was nevertheless higher than ten in the WHO African (12·6; 6·2–22·3), Eastern Mediterranean (15·6; 6·5–32·5), and South-East Asia (11·7; 4·1–27·1) regions.

Interpretation

Globally, people in prison are at high risk of contracting M tuberculosis infection and developing tuberculosis, with consistent disparities between prisons and the general population across regions. Tuberculosis control programmes should prioritise preventive interventions among incarcerated populations.

Funding

US National Institutes of Health.

中文翻译：

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被监禁人群中结核病的发病率和流行率：系统评价和荟萃分析

背景

监狱被认为是结核病的高危环境，但几乎没有对监狱中结核病的全球和区域发病率和流行率及其决定因素进行系统调查。我们进行了系统回顾和荟萃分析，以评估按地理区域划分的监禁人群中结核病的发病率和流行率。

方法

在这项系统评价和荟萃分析中，我们从 1980 年 1 月 1 日至 2020 年 11 月 15 日检索了 MEDLINE、Embase、Web of Knowledge 和 LILACS 电子数据库，以获取报告结核分枝杆菌感染发生率的横断面和队列研究、结核病的发病率或结核病在所有地理区域的被监禁者中的流行率。我们从个别研究中提取数据，并通过分层贝叶斯元回归模型计算发病率和患病率的汇总估计值。我们还按地区进行了亚组分析。监狱与普通人群之间的发病率比率是通过将监狱中结核病的发病率除以世卫组织对国家人口水平发病率的估计数计算得出的。

发现

我们确定了 159 项相关研究；11 人调查了结核分枝杆菌感染的发生率(n=16 318)，51 人调查了结核病的发病率 (n=1 858 323)，106 人调查了被监禁人群中结核病的流行率 (n=6 727 513)。结核分枝杆菌的总体合并发病率囚犯中的感染率为每 100 人年 15·0（95% 可信区间 [CrI] 3·8–41·6）。在世卫组织非洲（2190 [95% CrI 810-4840] 例）和东南亚（1550 [240-5300] 例）区域和南美洲（970 [460-1860] 例），北美最低（30 [20-50] 例）和世卫组织东地中海地区（270 [50-880] 例）。除北美和西太平洋地区外，全球所有区域的结核病患病率均高于每 100 000 名囚犯 1000 例，而世卫组织东南亚区域的结核病患病率最高（每 100 000 名囚犯 1810 [95% CrI 670–4000] 病例） ）。南美洲监狱与一般人群的发病率比（26·9；95% CrI 17·1–40·1）远高于其他地区，

解释

在全球范围内，监狱中的人感染结核分枝杆菌和发展为结核病的风险很高，不同地区的监狱和一般人群之间存在持续差异。结核病控制计划应优先考虑被监禁人群的预防性干预措施。

资金

美国国立卫生研究院。