New study in South Africa reveals half of people with tuberculosis have multimorbidity, which explains 60% of deaths
- News
5 August 2026
A new cohort study in South Africa highlights the high prevalence of comorbidities among people with tuberculosis (TB), and how the presence of several comorbidities (multimorbidity) explains 60% of mortality in people with TB.
The study, published in PLOS Global Public Health, followed 1,997 adults with bacteriologically confirmed pulmonary TB across two provinces in South Africa to assess the prevalence of comorbidities and their impact on mortality.
The study revealed 86% of participants had at least one of the five key TB-related comorbidities identified by the World Health Organization: diabetes, human immunodeficiency virus (HIV) infection, smoking, undernutrition, and alcohol use disorders.
Mortality risk was similar among participants with no comorbidities and those with a single comorbidity (10-11%). However, in the 48% of participants with multimorbidity, the risk of death increased substantially, with a 16% mortality rate among individuals with two comorbidities and 20% among those with three or more. HIV and undernutrition, particularly in combination, were strongly associated with high mortality both before and during TB treatment.
Overall, the findings demonstrate that TB multimorbidity is both highly prevalent and strongly associated with increased mortality. The authors conclude that integrating routine screening and management of comorbidities into TB care could significantly reduce the risk of death and will be an important component of global efforts to end tuberculosis.
Dr Greta Wood, who completed this work as part of an NIHR Academic Clinical Fellowship, said, “TB rarely exists in isolation, and our health services should reflect this. We urgently need to start looking for and treating comorbidities in people with TB – our work shows it could be lifesaving.”
Dr Tom Wingfield, senior author and Deputy Director of LSTM’s Centre for Tuberculosis Research, who previously contributed to the WHO’s Framework for Collective Action on Tuberculosis and Comorbidities said “We care for people not diseases. It is vital that we assess and address the complex social and health factors that people – especially people with TB living in challenging circumstances – face.”
This work was in collaboration with the Perinatal HIV Research Unit (PHRU) in Soweto, South Africa. Prof Neil Martinson, Executive Director of PHRU, commented, “We found that household members of people with TB in South Africa have a high burden of cardiovascular disease, tobacco use and other risks for TB. This was not previously known. Simply tracing TB contacts is not enough: comprehensive household-level healthcare interventions are warranted to save lives”.
