Infectious Disease · Medical Literature
Co-managing the double burden: strategies for simultaneously tackling infectious and non-communicable diseases.
Abstract
Evidence increasingly shows close, bidirectional links between infectious diseases (IDs) and non-communicable diseases (NCDs). However, research, health policy, and prevention practices still largely address them in separate frameworks. This scoping review summarises the current evidence on the interconnections between IDs and NCDs and explores integrated strategies for their prevention and management. This scoping review systematically searched PubMed, Web of Science, and Scopus for English-language systematic reviews and meta-analyses published between Jan 1, 2000, and April 20, 2026. Two reviewers independently screened eligible studies and extracted effect estimates for associations between IDs and NCDs. Evidence was grouped into two themes: associations between infectious agents and cancer, and the effects of NCDs on susceptibility to or severity of IDs. From 5799 records identified, 41 meta-analyses or systematic reviews met the inclusion criteria. The included reviews showed associations between pathogen infections and specific cancers, including hepatitis B and C virus infections with liver cancer, human papillomavirus infection with cervical cancer, and Helicobacter pylori infection with gastric cancer. IDs were also associated with an increased risk or burden of NCDs, as illustrated by the association between tuberculosis and chronic obstructive pulmonary disease. Conversely, NCDs could affect susceptibility to and outcomes of IDs; patients with diabetes or cardiovascular disease had higher risks of severe disease or adverse outcomes following tuberculosis, influenza, or COVID-19 infection. IDs and NCDs can interact through shared mechanisms, overlapping risk factors, and bidirectional pathways, underscoring the need for integrated strategies that combine prevention, early detection, treatment, and long-term management. At the public health level, this calls for health policies and financing mechanisms to move beyond disease-specific silos towards systemic frameworks that support integrated prevention and control, coordinated management, and cross-sectoral action.
Clinical relevance
This scoping review addresses a critical gap in global health practice: the persistent siloing of infectious disease (ID) and non-communicable disease (NCD) frameworks despite robust bidirectional biological and epidemiological linkages between them. It is directly relevant to clinicians managing high-burden populations—such as patients with diabetes, cardiovascular disease, or chronic respiratory illness—who carry disproportionate risk for severe ID outcomes. Given the convergence of these disease burdens in both low- and middle-income countries and aging populations worldwide, integrated co-management strategies are an urgent clinical and public health priority.
Key findings
1. From 5,799 records identified across PubMed, Web of Science, and Scopus (2000–April 2026), 41 meta-analyses or systematic reviews met inclusion criteria, providing a broad evidence base for ID–NCD interconnections. 2. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were associated with increased risk of hepatocellular carcinoma (liver cancer), consistent with established oncogenic mechanisms of chronic viral hepatitis. 3. Human papillomavirus (HPV) infection demonstrated a well-characterized association with cervical cancer, reinforcing the oncogenic role of viral pathogens in gynecologic malignancy. 4. Helicobacter pylori infection was associated with gastric cancer, highlighting a bacterially mediated carcinogenic pathway amenable to screening and eradication strategies. 5. Tuberculosis (TB) was associated with an increased risk or burden of chronic obstructive pulmonary disease (COPD), illustrating how IDs can precipitate or accelerate NCD development. 6. Patients with diabetes mellitus or cardiovascular disease demonstrated higher risks of severe disease or adverse outcomes following TB, influenza, or COVID-19 infection, underscoring the bidirectional vulnerability imposed by NCD comorbidity on ID susceptibility and severity. Note: specific pooled effect sizes, confidence intervals, and p-values were not reported in the available abstract.
Practice implications
Clinicians should routinely screen patients with major NCDs (particularly diabetes and cardiovascular disease) for TB exposure and ensure prioritized vaccination against influenza and COVID-19, given their elevated risk for severe infectious disease outcomes. Integrated care pathways should be implemented that simultaneously address oncogenic infection surveillance (HBV/HCV serologies, HPV vaccination and cervical screening, H. pylori testing and eradication) alongside NCD risk factor management, rather than deferring these to separate clinical silos. At the health system level, clinicians and department leads should advocate for coordinated, cross-specialty management protocols and financing structures that support dual-burden screening, prevention, and longitudinal follow-up within single care encounters.