Influence of Sex and Sex-Based Disparities on Prevalent Tuberculosis, Vietnam, 2017–2018

To assess sex disparities in tuberculosis in Vietnam, we conducted a nested, case–control study based on a 2017 tuberculosis prevalence survey. We defined the case group as all survey participants with laboratory–confirmed tuberculosis and the control group as a randomly selected group of participants with no tuberculosis. We used structural equation modeling to describe pathways from sex to tuberculosis according to an a priori conceptual framework. Our analysis included 1,319 participants, of whom 250 were case-patients. We found that sex was directly associated with tuberculosis prevalence (adjusted odds ratio for men compared with women 3.0 [95% CI 1.7–5.0]) and indirectly associated through other domains. The strong sex difference in tuberculosis prevalence is explained by a complex interplay of factors relating to behavioral and environmental risks, access to healthcare, and clinical manifestations. However, after controlling for all those factors, a direct sex effect remains that might be caused by biological factors.