MPH 504 Week 3 Disease Burden Analysis Example

Disease Burden Analysis: Tuberculosis in the Philippines Compared With Vietnam and the United States, and How Far the Numbers Can Be Trusted

Student Name

Chamberlain University

MPH 504: Cultural Competency and Global Public Health

Instructor Name

Month Day, Year

Disease Burden Analysis: Tuberculosis in the Philippines Compared With Vietnam and the United States, and How Far the Numbers Can Be Trusted

The Condition and the Settings

This analysis examines the burden of tuberculosis in the Philippines, the country of birth of many patients in the Alder County TB program where I work. It compares the Philippines with two reference settings chosen for different reasons. Vietnam is a regional neighbor with a similar income level and a national TB program of similar age, so differences between the two are more likely to reflect program and health system choices than wealth alone. The United States is the setting in which I practice and the place where people born in the Philippines who carry latent infection may later develop disease. The analysis covers adults and children together, uses the most recent year for which World Health Organization estimates are available, 2024, and treats pulmonary and extrapulmonary disease together.

Measures and Why More Than One Is Needed

Four measures are used. Estimated incidence counts new cases arising each year per 100,000 population, including cases never diagnosed. Estimated mortality is TB deaths per 100,000, which captures severity and the failure of care. Notification is the number of cases actually reported by the national program, which shows what the health system sees. Case detection is notification divided by estimated incidence, expressed as a percentage. Incidence alone would hide the fact that a large share of cases is never found; mortality alone would understate a disease that most people survive with treatment but that costs months of work and income.

The Figures

Table 1

Tuberculosis Burden Estimates, 2024

Note. Note. World Health Organization (2025) estimates; deaths include TB among people with HIV. U.S. case detection for 2023 was 86%.

The Philippines' estimated incidence, 625 per 100,000, is about three and a half times Vietnam's and about 200 times that of the United States. Its estimated mortality, 32 per 100,000, is more than two and a half times Vietnam's. Roughly 37,000 people died of TB in the Philippines in 2024, against about 650 in the United States (World Health Organization [WHO], 2025). By any of these measures, the Philippines carries one of the heaviest TB burdens in the world.

Comparison Against the Reference Settings

The comparison with Vietnam is the most informative. The two countries differ in incidence by more than threefold, yet the Philippines reports a higher case detection figure, 75% against 58%. Taken at face value, that would mean the Philippines finds a larger share of its cases. But case detection is a ratio of two numbers, one of them an estimate with a very wide interval, so it cannot bear much weight on its own. The comparison with the United States matters for my practice for a different reason: in 2023, 76% of U.S. TB cases occurred among people born outside the country, and the rate among non-U.S.-born people, 15.0 per 100,000, was nearly 19 times the rate among U.S.-born people, 0.8 (Williams et al., 2024). Much of that difference reflects infection acquired in high-burden countries and reactivated years later.

Data Quality as Part of the Argument

The uncertainty interval for the Philippines' incidence runs from 344 to 1,020 per 100,000. That interval is not a footnote; it means the true incidence could be about half or nearly double the central estimate. The interval is wide because incidence is not counted directly. It is modeled, in the Philippines' case largely from the 2016 national TB prevalence survey, which screened a representative sample of adults with symptom questions and chest radiography (Lansang et al., 2021). That survey found 1,159 bacteriologically confirmed cases per 100,000 adults, a prevalence 3.1 times higher than notifications would suggest, and no evidence of decline since the 2007 survey.

Two of its findings explain why routine data undercount. Only 32% of people with confirmed TB reported the symptoms that the screening questions asked about, so most would never have been referred for testing on symptoms alone. And among people with symptoms, only 19% had consulted a health worker (Lansang et al., 2021). A lower notification rate in one region of the Philippines therefore cannot be read as less disease; it may mean less screening, fewer clinics or more people paying for care at private pharmacies that do not report.

Estimates also change between reports. The 2024 WHO report gave the Philippines an incidence of 643 per 100,000 for 2023; the 2025 data set revised the same year to 632. A student comparing years across reports could mistake a revision for a trend. For the United States, by contrast, the national surveillance rate of 2.9 per 100,000 for 2023 is a count of reported cases (Williams et al., 2024), while the WHO estimate for that year, 3.1, adds an allowance for undiagnosed cases. Neither is wrong; they measure different things.

Determinants Behind the Pattern

The pattern is not explained by how people in the Philippines choose to live. TB spreads in crowded housing and poorly ventilated workplaces, progresses more often in people who are undernourished or have diabetes, and is found late when care is costly or far away (Lönnroth et al., 2009). In the Philippines, the cost of care is a direct barrier. The first national TB patient cost survey found that 42.4% of TB-affected households faced catastrophic costs, defined as costs above 20% of annual household income, even though diagnosis and drugs are provided free by the national program, because transport, food and lost income make up most of the cost (Florentino et al., 2022). Men were 2.5 times as likely as women to have pulmonary TB in the prevalence survey (Lansang et al., 2021), which points to occupational exposure, smoking and men's lower use of health services rather than to biology alone.

What the Comparison Implies

Three implications follow. First, in the Philippines, the biggest returns probably lie in finding people who would never be referred on symptoms, through screening of household contacts and high-risk communities with chest radiography, since the prevalence survey showed that symptom-based case finding misses most cases. Second, reducing the costs that fall on households, especially lost income and transport, matters as much as free drugs, because cost delays care and pushes families into debt. Third, for my own program in the United States, the burden in the Philippines means that adults born there carry a high likelihood of latent infection, which supports offering testing and short-course preventive treatment to that group rather than waiting for disease to appear.

References

Florentino, J. L., Arao, R. M. L., Garfin, A. M. C., Gaviola, D. M. G., Tan, C. R., Yadav, R. P., Hiatt, T., Morishita, F., Siroka, A., Yamanaka, T., & Nishikiori, N. (2022). Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first national TB patient cost survey in the Philippines. PLOS ONE, 17(2), e0264689. https://doi.org/10.1371/journal.pone.0264689

Lansang, M. A. D., Alejandria, M. M., Law, I., Juban, N. R., Amarillo, M. L. E., Sison, O. T., Cruz, J. R. B., Ang, C. F., Buensalido, J. A. L., Cañal, J. P. A., Castillo-Carandang, N. T., Cordero, C. P., Gaviola, D. M. G., Ladia, M. A. J., Mantaring, J. B. V., Mendoza, M. T., Salamat, M. S. S., Lam, H. Y., Tadolini, M., . . . Philippine NTPS 2016 Group. (2021). High TB burden and low notification rates in the Philippines: The 2016 national TB prevalence survey. PLOS ONE, 16(6), e0252240. https://doi.org/10.1371/journal.pone.0252240

Lönnroth, K., Jaramillo, E., Williams, B. G., Dye, C., & Raviglione, M. (2009). Drivers of tuberculosis epidemics: The role of risk factors and social determinants. Social Science & Medicine, 68(12), 2240-2246. https://doi.org/10.1016/j.socscimed.2009.03.041

Williams, P. M., Pratt, R. H., Walker, W. L., Price, S. F., Stewart, R. J., & Feng, P. I. (2024). Tuberculosis: United States, 2023. MMWR Morbidity and Mortality Weekly Report, 73(12), 265-270. https://doi.org/10.15585/mmwr.mm7312a4

World Health Organization. (2025). Global tuberculosis report 2025. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports