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Background <p>The coronavirus disease 2019 (COVID‑19) pandemic has disrupted tuberculosis (TB) services globally, but its impact on TB mortality in Japan—where the TB burden is concentrated among older adults—remains unclear. This study assessed trends in TB mortality before and during the COVID‑19 pandemic and examined whether being diagnosed during the pandemic was associated with TB mortality.</p> Methods <p>We analyzed anonymized, individual‑level cohort data for all patients notified with active TB to the national surveillance system between 1 January 2017 and 31 December 2022. TB‑specific mortality within 365 days of notification was evaluated across three periods: pre‑COVID‑19, pre‑Omicron, and Omicron. Mortality rates per 100 person‑years were calculated, and Cox proportional hazards models, allowing for a time‑varying effect of age, were used to estimate adjusted hazard ratios (aHRs) for TB death in the overall cohort and in age‑stratified analyses. Covariates included demographic, clinical, and health‑system factors recorded at baseline.</p> Results <p>TB mortality increased from 10.1 (95% confidence interval [CI] 9.7–10.4) to 12.7 per 100 person-years (95% CI 12.0-13.5) between the pre-COVID-19 and Omicron periods. This increase was driven primarily by adults aged ≥ 65 years, whose mortality rose from 15.2 (95% CI 14.7–15.8) to 18.5 per 100 person‑years (95% CI 17.4–19.7). In the adjusted models, being diagnosed during the Omicron period was associated with higher TB mortality among adults aged ≥ 65 years (aHR 1.10, 95% CI 1.03–1.18). Among those aged 0–64 years, estimates were imprecise due to the small number of TB deaths (aHR 1.09, 95% CI 0.78–1.53), but the point estimates were similar across age groups. Thus, the difference in statistical significance should not be interpreted as evidence of a true subgroup difference.</p> Conclusions <p>TB mortality in Japan increased during the COVID‑19 pandemic, particularly during the Omicron period, with the greatest impact observed among older adults. Although statistical significance varied by age group, similar point estimates suggest a broadly consistent effect across ages. These findings highlight the need to strengthen TB care pathways for older adults and ensure continuity of TB services during future public health emergencies.</p>

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Impact of COVID-19 on tuberculosis mortality in Japan: a retrospective analysis of national surveillance data from 2017 to 2022

  • 期刊论文

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  • 发表日期：

    2026年6月15日

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  • Lisa Kawatsu,
  • Kazuhiro Uchimura

摘要

Background

The coronavirus disease 2019 (COVID‑19) pandemic has disrupted tuberculosis (TB) services globally, but its impact on TB mortality in Japan—where the TB burden is concentrated among older adults—remains unclear. This study assessed trends in TB mortality before and during the COVID‑19 pandemic and examined whether being diagnosed during the pandemic was associated with TB mortality.

Methods

We analyzed anonymized, individual‑level cohort data for all patients notified with active TB to the national surveillance system between 1 January 2017 and 31 December 2022. TB‑specific mortality within 365 days of notification was evaluated across three periods: pre‑COVID‑19, pre‑Omicron, and Omicron. Mortality rates per 100 person‑years were calculated, and Cox proportional hazards models, allowing for a time‑varying effect of age, were used to estimate adjusted hazard ratios (aHRs) for TB death in the overall cohort and in age‑stratified analyses. Covariates included demographic, clinical, and health‑system factors recorded at baseline.

Results

TB mortality increased from 10.1 (95% confidence interval [CI] 9.7–10.4) to 12.7 per 100 person-years (95% CI 12.0-13.5) between the pre-COVID-19 and Omicron periods. This increase was driven primarily by adults aged ≥ 65 years, whose mortality rose from 15.2 (95% CI 14.7–15.8) to 18.5 per 100 person‑years (95% CI 17.4–19.7). In the adjusted models, being diagnosed during the Omicron period was associated with higher TB mortality among adults aged ≥ 65 years (aHR 1.10, 95% CI 1.03–1.18). Among those aged 0–64 years, estimates were imprecise due to the small number of TB deaths (aHR 1.09, 95% CI 0.78–1.53), but the point estimates were similar across age groups. Thus, the difference in statistical significance should not be interpreted as evidence of a true subgroup difference.

Conclusions

TB mortality in Japan increased during the COVID‑19 pandemic, particularly during the Omicron period, with the greatest impact observed among older adults. Although statistical significance varied by age group, similar point estimates suggest a broadly consistent effect across ages. These findings highlight the need to strengthen TB care pathways for older adults and ensure continuity of TB services during future public health emergencies.