{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:29:20Z","timestamp":1791725360332,"version":"4.3.4"},"reference-count":39,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fogarty International Centre","award":["K01TW010829"],"award-info":[{"award-number":["K01TW010829"]}]},{"name":"Fogarty International Centre","award":["K01TW011482"],"award-info":[{"award-number":["K01TW011482"]}]},{"name":"MRC","award":["MR\/W029227\/1"],"award-info":[{"award-number":["MR\/W029227\/1"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,2,17]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>During adolescence, tuberculosis incidence rises, with a greater increase in males compared with females. Tuberculosis notifications and estimates infrequently disaggregate adolescent age groups. Moreover, the factors that drive the increases in overall incidence and the male-to-female (MF) ratio remain unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We constructed a mechanistic model to estimate cumulative <jats:italic>Mycobacterium tuberculosis<\/jats:italic> infection and tuberculosis disease incidence in the WHO\u2019s 30 high-tuberculosis burden countries (HBCs), which represent 86%\u201390% of global tuberculosis incidence. We derived infection risk from tuberculosis prevalence and assortative social mixing based on sex and age (10\u201314 years vs 15\u201319 years old). We adjusted age subgroup-specific risks of disease progression by age- and sex-specific risks of low body mass index (BMI), pregnancy and postpartum period (PPP) and HIV coinfection. We calculated population attributable fractions (PAFs) to these factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 2019, 91.2 million (95% uncertainty interval (UI) 83.9 to 99.3 million) adolescents in the 30 HBCs had been infected with <jats:italic>M. tuberculosis<\/jats:italic>, and an estimated 1.0 million (95% UI 0.8 to 1.2 million) developed tuberculosis disease. The median PAF of tuberculosis disease to HIV, modified by antiretroviral therapy, was 1% and highest in Southern Africa. The median PAF for PPP among older adolescents of both sexes was 2.6%. The median PAF to low BMI was 16% and highest in South Asia. The MF risk ratio of tuberculosis disease was 1.2-fold higher among older adolescents, relative to young adolescents. The widening MF risk ratio was attributable mostly to low BMI, with a smaller contribution from sex-assortative social mixing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Globally, large numbers of adolescents have been infected by <jats:italic>M. tuberculosis<\/jats:italic> and develop tuberculosis disease. Low BMI is the most important contributor to the overall incidence of tuberculosis disease, as well as to the sex difference that widens with age.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-015368","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T18:15:21Z","timestamp":1741198521000},"page":"e015368","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Factors driving adolescent tuberculosis incidence by age and sex in 30 high-tuberculosis burden countries: a mathematical modelling study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2318-3802","authenticated-orcid":false,"given":"Silvia S","family":"Chiang","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA"},{"name":"Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan B","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander W","family":"Kay","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA"},{"name":"Baylor College of Medicine Children\u2019s Foundation-Eswatini, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5825-9347","authenticated-orcid":false,"given":"Peter J","family":"Dodd","sequence":"additional","affiliation":[{"name":"Division of Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"2025073015052714000_10.3.e015368.1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/S2352-4642(19)30337-2","article-title":"Adolescent tuberculosis","volume":"4","author":"Snow","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"2025073015052714000_10.3.e015368.2","unstructured":"World Health Organization . 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