“The Americas region, largely driven by Central and South America, meanwhile, had the largest estimated absolute number of TB cases among incarcerated people, clocking in at 30,509.”

Further regional prison differences:

  • Incidence decreased in several regions (for example, European, African and South-East Asian regions) and increased in the Americas region.
  • Trends in Europe were largely influenced by prisons in Russia which, after targeted interventions in prisons and reductions in incarceration over the past decade, have successfully reduced TB incidence in prisons.
  • Reasons for the increases in TB burden in the Americas may be multifactorial. Mass incarceration has risen dramatically in the Americas, likely leading to increased crowding.
  • The strong association found between crowding and TB incidence suggests this may be an important driver of the rising TB incidence in prisons from the Americas, especially in Central and South America.
  • While estimated incidence rates were high across WHO regions, there were differences within regions as well. For example, in the Americas, incidence in South and Central American countries (both more than 1,200 cases per 100,000 people per year) was considerably higher than those in North America (less than 50 incident cases per 100,000 people per year). Similarly, Eastern Europe had a substantially higher incidence than Western Europe.

Lead researcher in the study, Leonardo Martinez from the school of public health at Boston University, US, said: “This connection between TB and overcrowding suggests that efforts to limit the number of people who are detained may be one potential public health tool to combat the TB epidemic in prisons.

“The high incidence rate globally and across regions, low case detection rates, and consistency over time indicate that this population represents an important, under-prioritised group. Continued failure to detect, treat, and prevent tuberculosis in prisons will result in the unnecessary disease and deaths of many incarcerated people.

“And, of course, when incarcerated people are released from prison, they can take this infectious disease back into the communities in which they live, further contributing to the spread of tuberculosis globally. Greater focus and resources for addressing the tuberculosis epidemic in prisons are needed to protect the health of incarcerated people and their communities.”


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