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. 2021 Oct 20;75(11):e14867. doi: 10.1111/ijcp.14867

Prevalence of comorbid tuberculosis amongst COVID‐19 patients: A rapid review and meta‐analysis

Yadong Wang 1, Jie Xu 2, Ying Wang 2, Hongjie Hou 2, Li Shi 2, Haiyan Yang 2
PMCID: PMC8646527  PMID: 34670351

DISCLOSURES

The authors declare that they have no any potential conflict of interest regarding this submitted manuscript.

AUTHOR CONTRIBUTIONS

Yadong Wang and Haiyan Yang designed the study. Jie Xu, Ying Wang, Hongjie Hou and Li Shi performed literature search and data extraction. Jie Xu and Yadong Wang performed data analysis. Yadong Wang and Haiyan Yang wrote and reviewed the manuscript. All the authors approved the final manuscript.

Tuberculosis is reported to be associated with the severity and mortality amongst patients with coronavirus disease 2019 (COVID‐19). 1 However, the reported prevalence of comorbid tuberculosis amongst COVID‐19 patients varied greatly across the published studies. For example, the low prevalence of comorbid tuberculosis amongst COVID‐19 patients was reported in Tian et al’s study (0.4%) 2 and Yan et al’s study (0.2%) 3 and the relatively high prevalence of comorbid tuberculosis amongst COVID‐19 patients was reported in Hu et al’s study (4.5%) 4 and Zhang et al’s study (9.0%). 5 Therefore, it is needed to quantitatively estimate the pooled prevalence of comorbid tuberculosis amongst COVID‐19 patients using a meta‐analysis.

A systematic literature search was conducted independently by two investigators in PubMed, Web of Science, EMBASE, Springer, Elsevier‐ScienceDirect, Wiley Online Library, Scopus and Cochrane Library databases to select all eligible studies which were published from 1 January 2020 to 31 August 2021. The following keywords were used: “prevalence” or “incidence” or “rate” or “characteristics” and “tuberculosis” and “COVID‐19” or “SARS‐CoV‐2” or “2019‐nCoV” or “severe acute respiratory syndrome coronavirus 2” or “coronavirus disease 2019” or “2019 novel coronavirus”. All peer‐reviewed papers which were published in the English language were eligibly included if they provided the incidence rate of comorbid tuberculosis amongst COVID‐19 patients. Accordingly, we excluded case reports, review articles, duplicate publications, errata, comments and preprints. Reference lists of the retrieved articles were also screened to identify additional studies. This rapid systematic review and meta‐analysis was performed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA). 6

The pooled prevalence of comorbid tuberculosis amongst COVID‐19 patients was estimated using a random effects meta‐analysis model. 7 , 8 The statistical heterogeneity across studies was assessed by I 2 statistic and Cochrane Q test. 9 , 10 The risk of publication bias was evaluated by Begg's rank correlation test. 11 , 12 All statistical analyses were carried out using the package “meta” on R version 3.6.3 (R Foundation for Statistical Computing). A two‐tailed P value <.05 was regarded statistically significant.

A total of 114 eligible studies 2 , 3 , 4 , 5 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 with 405 596 COVID‐19 patients were included in this meta‐analysis. Amongst the included studies, 77 studies 2 , 3 , 4 , 5 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 were reported in Asia, 15 studies 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 were conducted in Africa, nine studies 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 were conducted in South America, five studies 110 , 111 , 112 , 113 , 114 were performed in North America, seven studies 115 , 116 , 117 , 118 , 119 , 120 , 121 were conducted in Europe and one study 122 was from multicountries. The baseline characteristics of the included studies are summarised in Table 1. Overall, our findings demonstrated that the prevalence of comorbid tuberculosis amongst COVID‐19 patients in this pooled meta‐analysis was 1.6% with 95% confidence interval (CI): 1.3%–1.9% (Figure 1). The regional tuberculosis prevalence in COVID‐19 patients was estimated as follows: Africa (4.1%, 95% CI: 0.0%–5.8%), Asia (1.1%, 95% CI: 0.9%–1.3%), South America (0.5%, 95% CI: 0.0%–1.0%), Europe (0.4%, 95% CI: 0.0%–0.6%) and North America (0.2%, 95% CI: 0.0%–0.4%), which revealed great variability in the prevalence of comorbid tuberculosis amongst COVID‐19 patients in different regions. Begg's test revealed that there was potential publication bias (P = .0017).

TABLE 1.

General information of eligible studies included in this meta‐analysis

Author Country Study design Male (%) Age a Sample size TB (%)
Hung IF China Randomised controlled trial 53.5 48.27 127 2 (1.6%)
Pande D India NR 48.1 50 27 1 (3.7%)
Du RH China NR 54.2 57.6 ± 13.7 179 8 (4.5%)
Hu Y China Retrospective study 47.1 53 (42‐62) 308 14 (4.5%)
Mo P China Retrospective study 55.5 54 (42‐66) 155 3 (1.9%)
Zeng JH China Retrospective study 47.6 46.58 416 8 (1.9%)
Sy KTL Philippines Cohort study NR NR 12 513 113 (0.9%)
Joeng HE Korea Cohort study 41.1 48.5 1824 7 (0.4%)
He G China Case series NR NR 139 3 (2.2%)
Li X China Ambispective study 50.9 60 (48‐69) 548 9 (1.6%)
Durrani M Pakistan Retrospective study 80 44 30 1 (3.3%)
Pachiega J Brazil NR NR NR 14 737 4 (0.03%)
Souza CDF Brazil Observational study 46.7 NR 197 1 (0.5%)
Panthee B Nepal NR 72.1 49.7 ± 19.2 79 5 (10.4%)
Chen T China Case series 53.2 54 (20‐91) 203 4 (2.0%)
Zhang JJ China Retrospective study 50.7 57 (25‐87) 140 2 (1.4%)
Lee C Korea Retrospective study 50 52.0 (37.5‐55.5) 10 0 (0%)
Asghar MS Pakistan Retrospective study 69 52.58 ± 15.68 100 1 (1%)
Pierrotti LC Brazil Retrospective study 49 51.9 (17‐78) 51 2 (3.9%)
Song J China Retrospective study 52 63 (49‐70) 961 20 (2.1%)
Borba MGS Brazil Randomised controlled trial NR NR 55 2 (3.6%)
Lee JY Korea Retrospective study 30.5 55.91 694 2 (0.3%)
Miciel EL Brazil Cross‐sectional study NR NR 416 1 (0.2%)
Tian J China Retrospective study 48.1 48.49 ± 14.36 721 3 (0.4%)
Kamal AF Indonesia Ambispective study 42.9 32.89 ± 17.42 35 2 (5.7%)
Hong D China Retrospective study 54.2 46.7 ± 17.7 168 8 (4.8%)
JeroniMo CMP Brazil Randomised controlled trial NR NR 362 8 (2.2%)
Yan N China Retrospective study 48.9 50 (39‐58) 1682 3 (0.2%)
Panda S India Prospective study 70.7 34.96 ± 13.4 225 1 (0.4%)
Wu Q China Retrospective study 47.8 48.78 492 4 (0.8%)
Zhang J China Retrospective study 48.3 60.0 (49.0‐69.0) 901 13 (1.4%)
Liu J China Retrospective study 53.4 57 (47‐67) 1190 15 (1.3%)
Yu HH China Retrospective study 50 62 (50‐70) 1561 20 (1.3%)
Boulle A South Africa Cohort study 31.6 NR 22 308 2128 (9.5%)
Yang C China Retrospective study 61.5 44 (33‐55) 104 2 (1.9%)
Barry M Saudi Arabia Case series NR NR 99 10 (10.1%)
Nachega JB Congo Cohort study 65.6 46 (34‐58) 766 19 (2.5%)
AI Kuwari HM Qatar Case series 88.9 35.8 ± 1.2 5685 13 (0.2%)
Ibrahim OR Nigeria Retrospective study 86.7 43 ± 16.0 45 2 (4.4%)
Gupta N India Retrospective study NR NR 1073 22 (2.1%)
Agarwal N India Observational study 83.2 47.6 ± 15.9 95 2 (2.1%)
Dai M China Retrospective study 59 51 ± 13 73 3 (4%)
Jin M China Retrospective study 33.9 57.52 ± 14.71 121 1 (0.8%)
Zhang X China NR 56.4 46.5 78 7 (9.0%)
Parker A South Africa Observational study 38.9 48.5 113 13 (11.5%)
Luo Y China Retrospective study 52.6 62 78 2 (2.56%)
Zhu J China Retrospective study 54 45.04 ± 46.50 50 3 (6%)
Tahtasakal CA Turkey Retrospective study 56.4 59 (19‐97) 534 2 (0.4%)
Dev N India Retrospective study 58 36 ± 13 55 0 (0%)
Li S China Retrospective study 50.6 61.9 (49.7‐69.5) 2924 52 (1.8%)
Sun C China Retrospective study 46 45 (31‐56) 129 1 (0.8%)
Feehan AK USA Cross‐sectional study NR NR 311 0 (0%)
Porto LC Brazil Retrospective study NR 40.5 (34‐49) 410 0 (0%)
Wang W China Retrospective study 61.2 44 (33‐50) 147 3 (2.1%)
Thiabaud A Switzerland Retrospective study 59.5 68 (54‐79) 3645 22 (0.9%)
Jeyaraman P India Retrospective study 69.7 60 (18‐80) 33 1 (3.0%)
Li C China Randomised controlled trial 46.8 54.0 (39.8‐63.3) 94 3 (3.2%)
Anaya JM Colombia Retrospective study 70.8 57.5 (51.8‐66.3) 120 0 (0%)
Yan B China Retrospective study 53.7 59.5 (14‐86) 190 1 (0.5%)
Patler C USA Cross‐sectional Study 91.9 37.4 (18.6‐68.9) 529 19 (3.6%)
Zheng B China Retrospective study 40.4 49.5 198 1 (0.5%)
Fisman DN Canada Cohort study 43 55 21 922 52 (0.2%)
Lee SG Korea Retrospective study 40.1 47.1 ± 19.0 7339 28 (0.4%)
Lu Y China Retrospective study 65 59 (54‐63) 77 1 (1.3%)
Bepouka BI Congo Retrospective study 67.4 49.6 ± 16.5 141 1 (0.7%)
Zhou S China Retrospective study 56 56.0 (45.3‐64.8) 62 0 (0%)
Yitao Z China Retrospective study 54 46 ± 17 257 3 (1.2%)
Li G Multi‐country NR 54 66 (58‐74) 399 6 (1.5%)
Zhang W China Retrospective study 53.6 40.6 500 3 (0.6%)
Abraha HE Ethiopia Retrospective study 63.3 29 (24‐38) 2617 8 (0.3%)
Kumar S India Retrospective study 87.1 64.5 (53.7‐70) 31 0 (0%)
Sun J China Prospective clinical trial 61.29 60.39 ± 10.20 31 1 (3.23%)
Hafiz M Indonesia Case series 62.8 55.9 ± 15.7 42 5 (11.9%)
Riou C South Africa Cohort study 57.9 52 (43‐57) 95 15 (15.8)
Meng M China Retrospective study 58.8 62.63 ± 13.49 415 8 (1.9%)
RECOVERY Collaborative Group UK Randomised controlled trial 64.3 63.5 11 558 46 (0.4%)
African COVID‐19 Critical Care Outcomes Study (ACCCOS) Investigators Ten African countries Prospective study 60.6 56 ± 16.11 3140 51 (1.7%)
Sahin B Turkey Prospective study 55.2 63.2 ± 13.8 58 10 (18.2%)
Marimuthu Y India Longitudinal study 56.6 45.3 ± 17.2 854 10 (1.2%)
Venturas J South Africa Retrospective study 53 50 (39‐60) 384 14 (4%)
Tsuchihashi Y Japan Retrospective study 55 60 516 1 (0.3%)
Kridin K Israel Case–control study 47.4 46.0 ± 19.3 6151 9 (0.29%)
Chanda D Zambia Retrospective study 57.3 48.2 443 21 (4.74%)
Xu J China Retrospective study 45.9 46.5 (34.3‐62.0) 98 2 (2%)
Zhang Q China Retrospective study 51.6 51.49 ± 17.39 157 1 (0.6%)
Dilogo IH Indonesia Randomised controlled trial 75 NR 40 2 (5%)
Pakdel F Iran Cross‐sectional study 66 52 15 1 (6.7%)
Agrupis KA Philippines Retrospective study 55.8 48 ± 17 500 41 (8.2%)
Prasetya IB Indonesia Retrospective study 62 43 (32‐54) 391 4 (1.2%)
Dave JA South Africa Retrospective study 38.3 40.0 (30.0‐52.0) 64 476 4736 (7.3%)
Zhou K China Retrospective study 53.5 47 144 4 (2.8%)
Meenakumari R India Retrospective study 76.9 39.53 ± 13.4 204 1 (0.5%)
Sharif N Bangladesh Retrospective study 65.8 39.8 ± 12.6 966 9 (0.9%)
Giubelan LI Romania Retrospective study NR NR 100 1 (1%)
Ali MR Bangladesh Cross‐sectional study 60.12 35 ± 14.90 326 27 (8.28%)
Kumar G India Prospective study 64.8 50 18 961 138 (0.7%)
Aggarwal R India Retrospective study 65.9 56 (41.5‐65) 247 21 (8.5%)
Kirenga B Uganda Randomised clinical trial 71.3 50 (38.5‐62.0) 136 4 (2.9%)
Sang L China Retrospective study 67.4 62.7 ± 13.3 190 1 (0.5%)
Bakamutumaho B Uganda Prospective study NR NR 11 0 (0%)
Suryananda TD Indonesia Prospective study 61.3 48.04 ± 11.66 75 5 (6.7%)
Fleitas PE Argentina Cross‐sectional study 49.7 37 (26‐51) 7968 84 (1.1%)
Ren P China Retrospective study 62.3 57 (48‐66) 80 1 (1.25%)
Badr OI Saudi Arabia Retrospective study 69.8 52.8 159 2 (1.26%)
Lee SW Korea Cohort study 37.3 NR 3882 51 (1.31%)
Maximiano Sousa F Switzerland Prospective study 59.5 68 (55‐80) 3590 21 (0.58%)
Sandoval M USA Retrospective study 38 24 (21‐27) 1853 1 (0.05%)
Munblit D Russia Cohort study 48.9 56 (46‐66) 2649 2 (0.08%)
Jassat W South Africa Cohort study 45.5 NR 151 779 5173 (3.41%)
Bushman D USA Case–control study 65.5 56 (23‐64) 1029 1 (0.1%)
Wang J China Retrospective study 59.2 57.0 (43.0‐66.0) 436 6 (1.38%)
Wolday D Ethiopia Prospective study 63.9 37 (28‐50) 751 1 (0.13%)
El‐Battrawy I Italy‐Spain‐Germany NR 58.6 NR 5810 15 (0.26%)
Arenas Jimenez MD Spain Retrospective study 70.8 72.4 ± 12.6 288 5 (1.7%)
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Abbreviations: NR, Not clearly reported; TB, tuberculosis; UK, United Kingdom; USA, the United States of America.

a

Indicates age (years) was presented as mean ± standard deviation (SD) or median (interquartile range, IQR).

FIGURE 1.

FIGURE 1

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The forest plot demonstrating the prevalence of comorbid tuberculosis amongst coronavirus disease 2019 (COVID‐19) patients on the basis of 114 studies with 405 596 cases

In conclusion, our findings demonstrated that the prevalence of comorbid tuberculosis amongst COVID‐19 patients was 1.6%, which varied greatly in different regions.

ACKNOWLEDGEMENTS

We would like to thank Wenwei Xiao, Xuan Liang, Peihua Zhang, Yang Li and Jian Wu (All are from Department of Epidemiology, School of Public Health, Zhengzhou University) for their kind help in searching articles and collecting data.

Funding information

This study was supported by grants from Joint Construction Project of Henan Medical Science and Technology Research Plan (grant number LHGJ20190679), National Natural Science Foundation of China (grant number 81973105) and Key Scientific Research Project of Henan Institution of Higher Education (grant number 21A330008). The funders have no role in the data collection, data analysis, preparation of manuscript and decision to submission.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are included in this article and available from the corresponding author upon reasonable request.

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Associated Data

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Data Availability Statement

The data that support the findings of this study are included in this article and available from the corresponding author upon reasonable request.

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