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Reviews of "Strong Effect of Demographic Changes on Tuberculosis Susceptibility in South Africa"

Reviewers: E Oren (San Diego State University) | 📒📒📒 ◻️◻️ • K Robsky (Georgetown University) | 📒📒📒◻️◻️ • N Tang (The Chinese University of Hong Kong) | 📒📒📒◻️◻️ • N Mhmoud (University of Khartoum) | 📗📗📗📗◻️ • C Yang (Fudan University) | 📘📘📘📘📘

Published onDec 12, 2023
Reviews of "Strong Effect of Demographic Changes on Tuberculosis Susceptibility in South Africa"
key-enterThis Pub is a Review of
Strong Effect of Demographic Changes on Tuberculosis Susceptibility in South Africa
Strong Effect of Demographic Changes on Tuberculosis Susceptibility in South Africa
Description

South Africa is among the world’s top eight TB burden countries, and despite a focus on HIV-TB co-infection, most of the population living with TB are not HIV co-infected. The disease is endemic across the country with 80-90% exposure by adulthood. We investigated epidemiological risk factors for tuberculosis (TB) in the Northern Cape Province, South Africa: an understudied TB endemic region with extreme TB incidence (645/100,000) and the lowest provincial population density. We leveraged the population’s high TB incidence and community transmission to design a case-control study with population-based controls, reflecting similar mechanisms of exposure between the groups. We recruited 1,126 participants with suspected TB from 12 community health clinics, and generated a cohort of 878 individuals (cases =374, controls =504) after implementing our enrollment criteria. All participants were GeneXpert Ultra tested for active TB by a local clinic. We assessed important risk factors for active TB using logistic regression and random forest modeling. Additionally, a subset of individuals were genotyped to determine genome-wide ancestry components. Male gender had the strongest effect on TB risk (OR: 2.87 [95% CI: 2.1-3.8]); smoking and alcohol consumption did not significantly increase TB risk. We identified two interactions: age by socioeconomic status (SES) and birthplace by residence ­­locality on TB risk (OR = 3.05, p = 0.016) – where rural birthplace but town residence was the highest risk category. Finally, participants had a majority Khoe-San ancestry, typically greater than 50%.  Epidemiological risk factors for this cohort differ from other global populations. The significant interaction effects reflect rapid changes in SES and mobility over recent generations and strongly impact TB risk in the Northern Cape of South Africa. Our models show that such risk factors combined explain 16% of the variance (r2) in case/control status.

To read the original manuscript, click the link above.

Summary of Reviews: This preprint examines risk factors for tuberculosis in South Africa, particularly for those who are not co-infected with HIV. The authors found an interaction between age and socioeconomic status and also between birth place and current residence. Reviewer concerns include insufficient motivation for interaction terms, limited covariates of interest, and insufficient details given for how the genomic data was used.

Reviewer 1 (Eyal O…) | 📒📒📒 ◻️◻️

Reviewer 2 (Katherine R…) | 📒📒📒 ◻️◻️

Reviewer 3 (Nelson T…) | 📒📒📒 ◻️◻️

Reviewer 4 (Najwa M…) | 📗📗📗📗◻️

Reviewer 5 (Chongguang Y…) | 📘📘📘📘📘

RR:C19 Strength of Evidence Scale Key

📕 ◻️◻️◻️◻️ = Misleading

📙📙 ◻️◻️◻️ = Not Informative

📒📒📒 ◻️◻️ = Potentially Informative

📗📗📗📗◻️ = Reliable

📘📘📘📘📘 = Strong

To read the reviews, click the links below. 

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lenkalee lenkalee:

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