The role of sex differences in the prevalence and transmission of tuberculosis

Tuberculosis (TB) epidemiology is characterized by significant differences in prevalence between men and women worldwide, with cases among men exceeding those found in women by a ratio of 2: 1 in some regions. In this paper, we review the literature concerning differences in TB prevalence by sex, as well as arguments that have been offered to explain these differences. We conclude that, while under-reporting and latent variables undoubtedly bias the observed differences in prevalence between males and females to some degree, there is also strong evidence that sex-based differences in TB prevalence represent real epidemiological differences. Such differences have implications for models of TB dynamics in countries with skewed population sex ratios such as China and India, and should be incorporated into models for TB control and forecasting. (C) 2012 Elsevier Ltd. All rights reserved.