TB incidence burden and temporal trends by regions and nations
In 2021, the global age-standardized incident rate(ASIR) for all HIV-negative TB was 103.00 per 100,000 population (95%UI: 92.21, 114.91), with an percentage change of -0.40% (95%UI: -0.43, -0.38) compared to 1990. For DS-TB, the ASIR was 97.29 per 100,000 population (95%UI: 85.79, 110.48), declining by -0.43% (95%UI: -0.47, -0.41) compared to 1990. MDR-TB showed an ASIR of 5.42 per 100,000 population (95%UI: 3.17, 9.34), with an increase of 4.09% (95% UI: 0.99, 12.15) compared to 1990. XDR-TB had an ASIR of 0.29 per 100,000 population (95%UI: 0.21, 0.42), with an percentage change of 0.03% (95%UI:I -0.25, 0.47) compared to 1990(Table 1). In addition, the EAPC for ASIR of TB, DS-TB, and MDR-TB were − 1.91% (95% CI: -2.01, -1.82), -2.40% (95% CI: -2.21, -1.97), and 2.05% (95% CI: 0.58, 3.54), respectively, from 1990 to 2021. In 2021, the global incidence number of TB was 8.41 millions cases (95% UI: 7.52 to 9.39 millions ), of which DS-TB accounted for 7.94 millions cases (95% UI: 7.01 to 9.02 millions ), MDR-TB accounted for 0.44 millions cases (95% UI: 0.26 to 0.77millions ), and XDR-TB accounted for 24 036 cases (95% UI: 17 144 to 34587) (Table S1).
The ASIR for all HIV-negative TB was 115.34 per 100,000 population (95%UI: 103.71, 128.58) in male in 2021, with an declining by -0.39% (95%UI: -0.42, -0.36) compared to 1990. The ASIR for all HIV-negative TB was 91.96 per 100,000 population (95%UI: 81.49, 102.62) in female, with an declining − 0.42% (95% UI: -0.45, -0.40) compared to 1990(Table 1). ASIR of TB, DS-TB, MDR-TB and XDR-TB show no significant differences between male and female individuals. Compared to 1990, the ASIR of TB and DS-TB have been declining in both males and females in 2021. However, the ASIR of MDR-TB has been increasing in both genders in 2021, For XDR-TB, the ASIR did not show a significant upward or downward trend in either males or females in 2021, compare to 2010.
In 2021, the ASIR of TB, DS-TB, and MDR-TB were highest in low SDI regions and lowest in high SDI regions. Conversely, the ASIR of XDR-TB was highest in high-middle SDI countries and lowest in high SDI regions (Table 1). Compared to 1990, the ASIR of TB and DS-TB in all five SDI regions showed a significant decline from 1990 to 2021. The ASIR of MDR-TB increased in low and low-middle SDI regions, while it decreased in high SDI regions and exhibited an initial increase followed by a decline in high-middle SDI regions. The ASIR of XDR-TB remained relatively unchanged over the years across all five regions, maintaining a low level (Table 1, Fig. 1).
In 2021, the ASID of TB was highest in Southern Sub-Saharan Africa, followed by Central Sub-Saharan Africa and Southern Sub-Saharan Africa, with ASID exceeding 280 per 100,000 population. In contrast, the ASID were lowest in High-income North America and Australasia, both below 10 per 100,000 population. The ASID of DS-TB in 2021 was also higher in Southern Sub-Saharan Africa, Central Sub-Saharan Africa, and South Asia, while it was lowest in High-income North America. The highest ASID of MDR-TB in 2021 was observed in Eastern Europe, followed by Southern Sub-Saharan Africa and South Asia, with the lowest rate in High-income North America. Additionally, the ASID of XDR-TB in 2021 was highest in Eastern Europe, followed by Central Asia, while remaining generally low in other regions (Table 1). Compared to 1990, the ASIR of TB showed a general decline globally and across 21 regions by 2021. The most significant decrease was observed in Andean Latin America, followed by High-income Asia Pacific and East Asia. Similarly, the ASIR of DS-TB also declined globally and in all 21 regions, with the greatest reduction in Andean Latin America and the smallest in Oceania. However, the ASIR of MDR-TB increased in several regions, including Southeast Asia, Oceania, Central Asia, Eastern Europe, Central Latin America, Tropical Latin America, North Africa and the Middle East, South Asia, Central Sub-Saharan Africa, Eastern Sub-Saharan Africa, Southern Sub-Saharan Africa, and Western Sub-Saharan Africa. The most substantial increase was seen in Central Asia, while Oceania and South Asia experienced significant decreases. In High-income North America, the ASIR of MDR-TB showed a noticeable trend (Table 1).
In 2021, the countries with the highest ASID of TB were Somalia (658.69 per 100,000 population, [95% UI: 568.35, 753.72]), Central African Republic (595.99 per 100,000 population, [95% UI: 543.91, 649.65]), and Eritrea (537.32 per 100,000 population, [95% UI: 470.66, 608.26]). The highest ASID of DS-TB were also observed in Somalia (600.76 per 100,000 population, [95% UI: 505.93, 703.81]), Central African Republic (583.74 per 100,000 population, [95% UI: 528.65, 634.31]), and Eritrea (514 per 100,000 population, [95% UI: 439.86, 594.40]). For MDR-TB, the countries with the highest ASID were Somalia (57.25 per 100,000 population, [95% UI: 14.12, 169.56]), Eswatini (45.56 per 100,000 population, [95% UI: 10.83, 118.38]), and Lesotho (36.03 per 100,000 population, [95% UI: 10.08, 93.29]). The regions with the highest ASID of XDR-TB included the Republic of Moldova (4.43 per 100,000 population, [95% UI: 2.62, 6.55]), Kyrgyzstan (4.25 per 100,000 population, [95% UI: 1.41, 8.44]), and Ukraine (3.83 per 100,000 population, [95% UI: 1.70, 6.58]) (Table S2). Compared to 1990, the ASID of TB decreased in all countries and regions except for the Philippines, where it increased (0.29%, [95% UI: 0.24, 0.34]) in 2021. Countries with the fastest increases in ASID of DS-TB included the Philippines (1.91%, [95% UI: 1.75, 2.08]), Qatar (1.11%, [95% UI: 0.89, 1.36]), and Papua New Guinea (0.91%, [95% UI: 0.76, 1.05]). Over the past 30 years, many countries have seen significant increases in ASID of MDR-TB, with the top three being Kyrgyzstan (412.76%, [95% UI: 59.32, 3878.83]), Uzbekistan (355.07%, [95% UI: 45.82, 4676.46]), and Azerbaijan (332.92%, [95% UI: 59.57, 3057.47]). For XDR-TB, the highest increases of ASID were in Papua New Guinea (4.04%, [95% UI: 0.07, 16.65]), Comoros (2.56%, [95% UI: 0.43, 16.56]), and Australia (2.39%, [95% UI: -0.24, 13.36]) in 2021, compared to 2010(Table S2).
Table 1
Age-standardized incident rate of tuberculosis, drug-susceptible tuberculosis, multidrug-resistant tuberculosis, and extensively drug-resistant tuberculosis in HIV-negative individuals in 2021, and percentage change of rates of age-standardised incidence during the 1990–2021 for Global Burden of Disease regions.
Characteristics | All HIV-negative tuberculosis | Drug-susceptible tuberculosis | Multidrug-resistant tuberculosis | Extensively drug-resistant tuberculosis |
Incidence rate,2021 (per 100000 populations) | Percentage change of incidence rate,1990, 2021 (95%: UI) | Incidence rate,2021 (per 100000 populations) | Percentage change of incidence rate,1990, 2021 (95%: UI) | Incidence rate,2021 (per 100000 populations) (95%: UI) | Percentage change of incidence rate,1990, 2021 (95%: UI) | Incidence rate, 2021 (per 100000 populations) (95%: UI) | Percentage change of incidence rate,2010–2021 (95%: UI) |
Global | 103(92.21, 114.91) | -0.4(-0.43, -0.38) | 97.29(85.79, 110.48) | -0.43(-0.47, -0.41) | 5.42(3.17, 9.34) | 4.09(0.99, 12.15) | 0.29(0.21, 0.42) | 0.03(-0.25, 0.47) |
Gender male | 115.34(103.71, 128.58) | -0.39(-0.42, -0.36) | 108.77(96.34, 123.53) | -0.42(-0.42, -0.39) | 6.2(3.68, 10.59) | 3.81(3.81, 11.37) | 0.37(0.27, 0.54) | 0.01(-0.27, 0.4) |
Gender female | 91.96(81.49, 102.62) | -0.42(-0.45, -0.4) | 87.04(76.09, 98.73) | -0.45(-0.45, -0.43) | 4.7(2.69, 8.35) | 4.42(4.42, 13.15) | 0.21(0.15, 0.31) | 0.08(-0.23, 0.57) |
East Asia | 40.28(36.25, 44.72) | -0.64(-0.66, -0.62) | 38.46(33.09, 43.35) | -0.65(-0.68, -0.62) | 1.67(0.43, 4.73) | -0.5(-0.9, 1.27) | 0.15(0.04, 0.42) | -0.16(-0.75, 1.14) |
Southeast Asia | 181.41(164.65, 198.8) | -0.42(-0.44, -0.4) | 177.5(161.1, 194.22) | -0.43(-0.45, -0.42) | 3.55(1.87, 6.11) | 3.35(0.42, 10.54) | 0.37(0.2, 0.64) | -0.04(-0.52, 0.75) |
Oceania | 122.03(111.69, 133.54) | -0.24(-0.28, -0.2) | 116.92(106.56, 128.33) | -0.27(-0.32, -0.23) | 4.47(1.33, 10.23) | 44.57(6.85, 246.15) | 0.64(0.19, 1.49) | 2.4(-0.23, 10.27) |
Central Asia | 53.28(46.65, 60.59) | -0.45(-0.49, -0.4) | 39.87(33.51, 47.29) | -0.59(-0.64, -0.53) | 11.07(7.45, 15.82) | 65.97(18.74, 205.01) | 2.35(1.59, 3.35) | -0.12(-0.42, 0.24) |
Central Europe | 13.64(11.86, 15.67) | -0.61(-0.64, -0.58) | 13.33(11.59, 15.36) | -0.62(-0.65, -0.58) | 0.26(0.12, 0.5) | 0.33(-0.54, 2.81) | 0.06(0.03, 0.11) | -0.18(-0.71, 1.13) |
Eastern Europe | 57.89(48.95, 70.52) | -0.42(-0.46, -0.34) | 37.64(29.22, 48.03) | -0.62(-0.69, -0.54) | 16.73(10.38, 24.72) | 14.12(4.44, 38.75) | 3.52(2.18, 5.2) | 0.06(-0.36, 0.67) |
High-income Asia Pacific | 15.44(13.33, 17.83) | -0.66(-0.69, -0.63) | 15.25(13.14, 17.66) | -0.66(-0.7, -0.63) | 0.17(0.05, 0.55) | -0.34(-0.87, 2.06) | 0.02(0.01, 0.07) | -0.07(-0.71, 1.79) |
Australasia | 5.13(4.37, 6.01) | -0.4(-0.44, -0.35) | 4.96(4.22, 5.84) | -0.42(-0.46, -0.36) | 0.15(0.06, 0.32) | 2.48(-0.07, 15.23) | 0.02(0.01, 0.04) | 1.54(-0.3, 7.57) |
Western Europe | 5.69(4.79, 6.76) | -0.56(-0.59, -0.54) | 5.55(4.67, 6.59) | -0.57(-0.6, -0.55) | 0.13(0.08, 0.21) | 0.29(-0.31, 1.49) | 0.02(0.01, 0.03) | 0.26(-0.17, 1.06) |
Southern Latin America | 13.63(11.79, 15.97) | -0.51(-0.55, -0.47) | 13.43(11.58, 15.76) | -0.51(-0.55, -0.47) | 0.17(0.05, 0.54) | 0.85(-0.66, 7.55) | 0.02(0.01, 0.08) | 0.13(-0.66, 1.92) |
High-income North America | 2.31(1.99, 2.73) | -0.44(-0.47, -0.41) | 2.27(1.95, 2.68) | -0.44(-0.47, -0.4) | 0.03(0.01, 0.08) | -0.72(-0.9, -0.17) | 0(0, 0.01) | 0.68(-0.32, 3.07) |
Caribbean | 34.13(30.04, 38.28) | -0.32(-0.36, -0.27) | 33.96(29.9, 38.12) | -0.32(-0.36, -0.27) | 0.16(0.06, 0.38) | -0.23(-0.8, 1.63) | 0.01(0, 0.04) | 0.85(-0.4, 4.09) |
Andean Latin America | 61.55(53.60, 71.69) | -0.69(-0.71, -0.66) | 57(49.38, 67.2) | -0.71(-0.74, -0.68) | 0.92(0.21, 2.64) | 1.56(-0.16, 7.29) | 0.35(0.18, 0.69) | 0.27(-0.34, 1.37) |
Central Latin America | 19.25(16.92, 21.93) | -0.55(-0.58, -0.52) | 18.64(16.34, 21.36) | -0.56(-0.6, -0.53) | 0.57(0.24, 1.13) | 7.84(1.9, 25.03) | 0.05(0.02, 0.09) | 0.45(-0.29, 1.71) |
Tropical Latin America | 29.53(25.53, 34.40) | -0.46(-0.5, -0.42) | 28.54(24.31, 33.39) | -0.48(-0.53, -0.44) | 4.2(2.07, 8.29) | 34.16(3.63, 281.56) | 0.07(0.02, 0.21) | 0.87(-0.53, 4.22) |
North Africa and Middle East | 28.94(25.47, 32.99) | -0.6(-0.63, -0.57) | 28.06(24.54, 32.01) | -0.61(-0.64, -0.59) | 0.84(0.47, 1.55) | 3.44(0.78, 11.04) | 0.04(0.02, 0.08) | -0.15(-0.6, 0.75) |
South Asia | 204.05(180.62, 231.66) | -0.5(-0.54, -0.46) | 189.19(161.61, 220.04) | -0.54(-0.59, -0.49) | 14.46(4.55, 32.75) | 35.35(4.84, 179.68) | 0.4(0.13, 0.91) | 0.4(-0.49, 2.16) |
Central Sub-Saharan Africa | 392.31(352.37, 437.48) | -0.28(-0.31, -0.25) | 382.38(339.78, 425.41) | -0.3(-0.33, -0.26) | 9.83(2.91, 25.87) | 4.34(0.09, 27.42) | 0.1(0.03, 0.26) | 0.23(-0.61, 2.94) |
Eastern Sub-Saharan Africa | 282.94(250.78, 314.99) | -0.51(-0.53, -0.48) | 271.21(240.14, 302.7) | -0.53(-0.55, -0.5) | 11.61(6.94, 19.19) | 18.98(5.94, 50.59) | 0.12(0.07, 0.19) | 0.4(-0.17, 1.29) |
Southern Sub-Saharan Africa | 417.09(370.35, 470.4) | -0.23(-0.29, -0.17) | 401.31(352.7, 454.55) | -0.26(-0.32, -0.2) | 15.65(7.14, 32.63) | 6.06(0.98, 28.89) | 0.13(0.06, 0.29) | 0.15(-0.54, 1.73) |
Western Sub-Saharan Africa | 177.75(155.88, 200.88) | -0.51(-0.54, -0.47) | 171.17(149.53, 193.21) | -0.53(-0.56, -0.49) | 6.52(3.06, 13.88) | 4.91(1.28, 14.69) | 0.06(0.03, 0.13) | -0.05(-0.5, 0.9) |
High-middle SDI | 35.45(31.53, 40.33) | -0.56(-0.58, -0.54) | 31.02(26.95, 35.55) | -0.61(-0.63, -0.58) | 3.77(2.33, 5.85) | 1.57(-0.04, 6.61) | 0.66(0.41, 0.95) | -0.07(-0.41, 0.37) |
High SDI | 9.19(8.04, 10.61) | -0.57(-0.59, -0.55) | 8.96(7.8, 10.38) | -0.58(-0.6, -0.55) | 0.21(0.12, 0.38) | -0.18(-0.6, 0.69) | 0.02(0.01, 0.04) | 0.02(-0.36, 0.72) |
Low-middle SDI | 184.63(164.33, 208.36) | -0.5(-0.53, -0.47) | 173.93(152.62, 199.25) | -0.53(-0.57, -0.5) | 10.35(4.21, 21.99) | 24.56(6.35, 79.12) | 0.36(0.18, 0.7) | 0.25(-0.35, 1.38) |
Low SDI | 240.81(214.04, 269.42) | -0.46(-0.48, -0.44) | 229.44(203.43, 257.18) | -0.48(-0.51, -0.46) | 11.13(6.51, 19.05) | 10.68(4.2, 25.42) | 0.23(0.12, 0.47) | 0.29(-0.41, 1.87) |
Middle SDI | 97.92(88.07, 107.77) | -0.42(-0.45, -0.4) | 93.04(83.33, 103.82) | -0.44(-0.48, -0.41) | 4.63(2.22, 8.39) | 1.46(-0.22, 7.57) | 0.25(0.15, 0.4) | 0.09(-0.34, 0.81) |
TB death burden and temporal trends by regions and nations
In 2021, the global ASDR of TB was 13.96 per 100,000 population (95% UI: 12.61, 15.72), with an decline of -0.44% (95% UI: -0.61 to -0.23) compared to 1990. The ASDR for DS-TB, MDR-TB, and XDR-TB in 2021 were 12.58 per 100,000 population (95% UI: 10.91, 14.42), 1.28 per 100,000 population (95% UI: 0.5, 2.53), and 0.09 per 100,000 population (95% UI: 0.04, 0.18), respectively. DS-TB exhibited an decline in ASDR of 0.49% (95% UI: -0.63, -0.28) compared to 1990, while ASDR of MDR-TB showed a substantial increase of 36.08% (95% UI: 5.11, 208.98) compared to 1990, and ASDR of XDR-TB had an percentage change of 2.24% (95% UI: -0.26, 9.60) compared to 2010(Table 2). The EAPC for ASDR of TB, DS-TB, and MDR-TB from 1990 to 2021 were − 3.53% (95% CI: -3.71 to -3.36), -3.79% (95% CI: -3.92 to -3.67), and 1.18% (95% CI: -0.43, 2.82), respectively. In 2021, TB resulted in 1.16 millions deaths (95% UI: 1.05, 1.31), with DS-TB accounting for 1.05 millions deaths (95% UI: 0.91, 1.20 millions), MDR-TB causing 0.11 million deaths (95% UI: 0.42, 0.21 million), and XDR-TB leading to 7 946 deaths (95% UI: 3326, 14859) (Table S3).
In 2021, the ASDR for all HIV-negative TB in males was 10.22 per 100,000 population (95% UI: 9.28, 11.33), with an declining of -0.65% (95%UI: -0.72, -0.47) compared to 2021. In females, the ASDR was 16.41 per 100,000 population (95% UI: 13.92, 19.67), with an decline of -0.66% (95% UI: -0.71, -0.62) compared to 2021. ASDR for TB, DS-TB, and XDR-TB were higher in females than in males, whereas the ASDR for MDR-TB was higher in males. Compared to 1990, the ASDR for TB and DS-TB showed a general decline in both males and females in 2021. However, the ASDR for MDR-TB increased in both genders in 2021, while the ARDS for XDR-TB remained relatively unchanged in both male and female individuals in 2021, compared to 2010.
In 2021, the ASDR for TB, DS-TB, and MDR-TB were highest in low SDI regions, with the ASDR or TB and DS-TB significantly exceeding those in other regions. The ASDR for XDR-TB was highest in low-middle SDI countries. Over the past 30 years, the ASDR for TB and DS-TB have generally shown a significant decline across all five SDI regions. However, the ASDR for MDR-TB increased in low-middle and low SDI regions, showed an initial rise followed by a decline in middle and high-middle SDI regions, and a marked decrease in high SDI regions. The ASDR for XDR-TB exhibited an initial increase followed by a decline in high-middle SDI regions but remained relatively unchanged in the other four SDI regions from 2010 t0 2021 (Table 2, Fig. 2).
In 2021, the overall ASDR due to TB was highest in Central Sub-Saharan Africa, followed by South Asia and Southern Sub-Saharan Africa, and lowest in High-income North America. The ASDR due to DS-TB was highest in Central Sub-Saharan Africa, followed by South Asia and Southern Sub-Saharan Africa, and lowest in Western Europe and High-income North America. The ASDR of MDR-TB was highest in South Asia, followed by Central Sub-Saharan Africa and Southern Sub-Saharan Africa, and lowest in High-income North America. The highest ASDR due to XDR-TB was observed in Central Asia, followed by Oceania and Eastern Europe. Comparing 2021 to 1990, the ASDR of TB decreased across all 21 global regions, with the most rapid declines observed in East Asia, Andean Latin America, and High-income Asia Pacific, while the slowest decline occurred in Southern Sub-Saharan Africa. Similarly, the ASDR due to DS-TB decreased in all 21 regions, with the fastest declines in East Asia, Andean Latin America, and High-income Asia Pacific, and the slowest decline in Southern Sub-Saharan Africa. The ASDR of MDR-TB increased in Oceania, Central Asia, South Asia, Eastern Europe, Tropical Latin America, Eastern Sub-Saharan Africa, Southern Sub-Saharan Africa, and Western Sub-Saharan Africa, but decreased in Western Europe and High-income North America.
In 2021, the countries with the highest ASDR of TB were the Central African Republic (264.97 per 100,000 population [95% UI: 173.66, 356.79]), Somalia (264.82 per 100,000 population [95% UI: 158.28, 456.76]), and Lesotho (213.42 per 100,000 population [95% UI: 143.05, 274.31]). For DS-TB, the highest ASDR were observed in the Central African Republic (256.59 per 100,000 population [95% UI: 168.59, 347.82]), Somalia (226.71 per 100,000 population [95% UI: 126.3, 382.94]), and Lesotho (192.43 per 100,000 population [95% UI: 129.58, 252.95]). The highest ASDR of MDR-TB were found in Somalia (37.6 per 100,000 population [95% UI: 7.63, 109.59]), Lesotho (20.70 per 100,000 population [95% UI: 4.74, 58.94]), and Eswatini (17.19 per 100,000 population [95% UI: 3.55, 44.64]). For XDR-TB, the highest ASDR were in Mongolia (1.01 per 100,000 population [95% UI: 0.22, 2.62]), Tajikistan (0.88 per 100,000 population [95% UI: 0.3, 1.79]), and Kyrgyzstan (0.80 per 100,000 population [95% UI: 0.28, 1.44]) (Table S2). Compared to 1990, the ASDR of TB in 2021 did not significantly increase in most countries and regions, with many showing a declining trend. However, declines were slower in Lesotho (0.39% [95% UI: -0.14, 1.09]), Zimbabwe (0.35% [95% UI: -0.2, 0.91]), and Somalia (-0.11% [95% UI: -0.32, 0.19]). ASDR of DS-TB decreased in many countries but increased in some, with notable rises in Zimbabwe (1.08% [95% UI: 0.17, 2.04]), Somalia (0.64% [95% UI: 0.04, 1.34]), and Lesotho (0.62% [95% UI: 0.02, 1.52]). The highest increases in ASDR of MDR-TB were observed in Somalia (111.77% [95% UI: 14.93, 1511.71]), Kyrgyzstan (89.45% [95% UI: 13.95, 858.79]), and Turkmenistan (84.75% [95% UI: 16.35, 1030.45]).
Table 2
Age-standardized death rate of tuberculosis, drug-susceptible tuberculosis, multidrug-resistant tuberculosis, and extensively drug-resistant tuberculosis in HIV-negative individuals in 2021, and percentage change of rates of age-standardised incidence during the 1990–2021 for Global Burden of Disease regions.
Characteristics | All HIV-negative tuberculosis | Drug-susceptible tuberculosis | Multidrug-resistant tuberculosis | Extensively drug-resistant tuberculosis |
Death rate,2021 (per 100000 populations) | Percentage change of death rate,1990–2021 (95%: UI) | Death rate,2021 (per 100000 populations) | Percentage change of death rate,1990, 2021 (95%: UI) | Death rate,2021 (per 100000 populations) | Percentage change of death rate,1990, 2021 (95%: UI) | Death rate,2021 (per 100000 populations) | Percentage change of death rate,2010, 2021 (95%: UI) |
Global | 13.96(12.61, 15.72) | -0.65(-0.69, -0.55) | 12.58(10.91, 14.42) | -0.68(-0.73, -0.59) | 1.28(0.5, 2.53) | 2.45(0.37, 7.39) | 0.09(0.04, 0.18) | -0.21(-0.45, 0.1) |
Gender male | 10.22(9.28, 11.33) | -0.65(-0.72, -0.47) | 9.21(8.01, 10.41) | -0.68(-0.75, -0.52) | 0.95(0.37, 1.88) | 2.36(0.34, 7.87) | 0.06(0.02, 0.12) | -0.25(-0.47, 0.07) |
Gender female | 16.41(13.92, 19.67) | -0.66(-0.71, -0.62) | 1.65(0.66, 3.26) | -0.7(-0.74, -0.65) | 0.13(0.06, 0.25) | 2.49(0.43, 7.73) | 0.21(0.15, 0.31) | -0.13(-0.42, 0.3) |
East Asia | 2.43(1.99, 3.04) | -0.88(-0.91, -0.83) | 2.2(1.68, 2.76) | -0.89(-0.92, -0.84) | 0.19(0.05, 0.48) | -0.83(-0.96, -0.33) | 0.04(0.01, 0.1) | -0.37(-0.76, 0.45) |
Southeast Asia | 27.25(23.53, 31.56) | -0.69(-0.74, -0.55) | 26.12(22.56, 30.36) | -0.7(-0.75, -0.57) | 0.95(0.35, 2.03) | 1.06(-0.28, 4.93) | 0.19(0.06, 0.43) | -0.28(-0.61, 0.28) |
Oceania | 36.51(29.41, 45.06) | -0.44(-0.61, -0.23) | 33.69(26.45, 41.69) | -0.49(-0.63, -0.28) | 2.36(0.52, 6.26) | 36.08(5.11, 208.98) | 0.46(0.1, 1.26) | 2.24(-0.26, 9.6) |
Central Asia | 4.67(4.12, 5.27) | -0.62(-0.67, -0.57) | 2.9(1.94, 3.78) | -0.76(-0.84, -0.69) | 1.21(0.67, 1.86) | 26.92(9.34, 81.81) | 0.56(0.31, 0.9) | -0.42(-0.59, -0.22) |
Central Europe | 0.99(0.91, 1.07) | -0.79(-0.8, -0.77) | 0.94(0.86, 1.02) | -0.8(-0.81, -0.78) | 0.03(0.01, 0.07) | -0.35(-0.77, 0.85) | 0.02(0.01, 0.04) | -0.4(-0.79, 0.57) |
Eastern Europe | 2.95(2.67, 3.31) | -0.47(-0.52, -0.41) | 1.54(0.91, 2.2) | -0.72(-0.83, -0.6) | 0.97(0.55, 1.39) | 5.6(1.62, 16.99) | 0.45(0.25, 0.7) | -0.49(-0.65, -0.25) |
High-income Asia Pacific | 1.1(0.93, 1.23) | -0.84(-0.87, -0.82) | 1.07(0.89, 1.2) | -0.85(-0.87, -0.83) | 0.02(0, 0.07) | -0.75(-0.95, 0.04) | 0.01(0, 0.02) | -0.19(-0.75, 1.43) |
Australasia | 1.49(1.39, 1.6) | -0.76(-0.78, -0.74) | 1.45(1.33, 1.57) | -0.77(-0.8, -0.75) | 0.04(0.01, 0.11) | 0.26(-0.68, 4.32) | 0(0, 0.01) | 0.69(-0.53, 4.59) |
Western Europe | 0.14(0.13, 0.15) | -0.82(-0.84, -0.82) | 0.13(0.11, 0.15) | -0.83(-0.84, -0.82) | 0.01(0, 0.02) | -0.51(-0.73, -0.04) | 0(0, 0.01) | -0.13(-0.42, 0.36) |
Southern Latin America | 0.27(0.24, 0.29) | -0.75(-0.77, -0.73) | 0.26(0.23, 0.28) | -0.76(-0.78, -0.73) | 0.01(0.01, 0.02) | -0.11(-0.82, 2.81) | 0.01(0, 0.03) | -0.05(-0.71, 1.34) |
High-income North America | 0.15(0.14, 0.16) | -0.79(-0.8, -0.79) | 0.14(0.13, 0.15) | -0.79(-0.8, -0.77) | 0(0, 0.01) | -0.9(-0.97, -0.7) | 0(0, 0) | 0.46(-0.4, 2.66) |
Caribbean | 7.05(5.66, 8.92) | -0.6(-0.71, -0.44) | 6(4.37, 7.78) | -0.6(-0.71, -0.44) | 0.89(0.32, 1.97) | -0.48(-0.9, 1.01) | 0.01(0, 0.03) | 0.69(-0.47, 3.58) |
Andean Latin America | 2.41(2.13, 2.75) | -0.86(-0.89, -0.82) | 2.25(1.95, 2.6) | -0.88(-0.92, -0.84) | 0.14(0.05, 0.3) | 0.09(-0.62, 2.66) | 0.15(0.05, 0.35) | -0.01(-0.49, 0.88) |
Central Latin America | 5.07(3.37, 12.21) | -0.82(-0.84, -0.80) | 5.01(3.34, 12.07) | -0.84(-0.86, -0.81) | 0.05(0.01, 0.15) | 2.96(0.4, 9.6) | 0.02(0.01, 0.05) | 0.16(-0.41, 1.12) |
Tropical Latin America | 2.29(2.18, 2.38) | -0.71(-0.72, -0.70) | 2.13(1.78, 2.3) | -0.73(-0.77, -0.71) | 0.13(0.03, 0.39) | 14.68(1.29, 117.25) | 0.02(0, 0.07) | 0.38(-0.61, 2.63) |
North Africa and Middle East | 4.37(3.44, 6.33) | -0.76(-0.81, -0.65) | 4.07(3.1, 5.96) | -0.77(-0.82, -0.67) | 0.28(0.09, 0.7) | 2.47(0.26, 8.38) | 0.02(0.01, 0.06) | -0.26(-0.64, 0.66) |
South Asia | 81.6(67.28, 98.09) | -0.71(-0.75, -0.61) | 75.31(61.01, 91.46) | -0.75(-0.82, -0.65) | 6.21(2.4, 12.52) | 17.22(2.42, 86.95) | 0.22(0.05, 0.53) | 0.17(-0.55, 1.46) |
Central Sub-Saharan Africa | 102.62(73.09, 148.92) | -0.46(-0.59, -0.27) | 97.45(68.51, 142.04) | -0.49(-0.61, -0.3) | 5.1(1.24, 17.43) | 3.31(-0.14, 21.53) | 0.07(0.02, 0.24) | 0.19(-0.59, 2.63) |
Eastern Sub-Saharan Africa | 33.11(29.19, 39.07) | -0.63(-0.7, -0.53) | 28.66(22.23, 35.03) | -0.66(-0.73, -0.56) | 4.22(1.04, 9.67) | 15.05(4.44, 39.1) | 0.09(0.03, 0.18) | 0.34(-0.17, 1.09) |
Southern Sub-Saharan Africa | 60.44(53.28, 69.99) | -0.26(-0.44, -0.1) | 55.85(46.97, 65.85) | -0.31(-0.48, -0.15) | 4.53(1.65, 10.15) | 5.4(0.86, 26.35) | 0.06(0.02, 0.15) | -0.09(-0.59, 1.05) |
Western Sub-Saharan Africa | 45.01(36.28, 54.17) | -0.58(-0.68, -0.42) | 41.9(33.04, 51.36) | -0.6(-0.69, -0.46) | 3.07(1.07, 6.62) | 4.09(1.15, 12.49) | 0.04(0.01, 0.09) | -0.05(-0.48, 0.76) |
High-middle SDI | 2.07(1.85, 2.37) | -0.79(-0.83, -0.72) | 1.71(1.43, 2.04) | -0.82(-0.86, -0.76) | 0.27(0.15, 0.46) | -0.23(-0.7, 1.43) | 0.09(0.05, 0.15) | -0.54(-0.67, -0.37) |
High SDI | 0.6(0.54, 0.68) | -0.8(-0.82, -0.77) | 0.58(0.51, 0.64) | -0.81(-0.83, -0.78) | 0.02(0.01, 0.05) | -0.65(-0.82, -0.33) | 0.01(0, 0.01) | -0.23(-0.48, 0.26) |
Low-middle SDI | 33.81(29.83, 38.66) | -0.67(-0.73, -0.56) | 30.15(24.74, 34.81) | -0.71(-0.77, -0.61) | 3.45(1.07, 7.7) | 13.92(3.62, 43.57) | 0.21(0.07, 0.46) | 0.09(-0.43, 0.96) |
Low SDI | 60.16(52.67, 70.84) | -0.61(-0.67, -0.5) | 54.91(47.18, 64.86) | -0.65(-0.71, -0.55) | 5.09(2.05, 10.44) | 7.74(3.27, 17) | 0.16(0.05, 0.36) | 0.18(-0.4, 1.52) |
Middle SDI | 9.85(8.81, 11.63) | -0.74(-0.78, -0.64) | 8.98(7.79, 10.68) | -0.76(-0.8, -0.67) | 0.78(0.28, 1.58) | 0.06(-0.64, 2.4) | 0.08(0.03, 0.16) | -0.24(-0.53, 0.13) |
TB DALY burden and temporal trends by regions and nations
In 2021, the global age-standardized DALY rate for all TB was estimated at 580.26 per 100,000 population (95% UI: 522.37, 649.82), with an declining by -0.65% (95% UI:-0.69, -0.57) compared to 1990. For DS-TB, the age-standardized DALY rate was 526.03 per 100,000 population (95% UI: 457.25, 596.46), declining by -0.68% (95% UI: -0.72, -0.60) compared to 1990. MDR-TB had a age-standardized DALY rate of 50.76 per 100,000 population (95% UI: 21.28, 99.37), with an increase of 2.68% (95% UI: 0.53, 7.70) compared to 1990. XDR-TB showed a age-standardized DALY rate of 0.58 per 100,000 population (95% UI: 0.19, 1.39), with an percentage change of -0.25% (95% UI: -0.47, 0.05) compared to 1990. The EAPC of the age-standardized DALY rate of TB, DS-TB, and MDR-TB were − 3.5% (95% CI: -3.67, -3.32), -3.75% (95% CI: -3.87, -3.62), and 1.36% (95% CI: -0.30, 3.04) from 1990 to 2021, respectively. In 2021, TB caused a total of 46.98 millions DALYs (95% UI: 42.48, 52.46 millions), with DS-TB contributing 42.56 millions DALYs (95% UI: 36.84, 48.24 millions), MDR-TB contributing 4.13 millions DALYs (95% UI: 1.71, 8.60 millions), and XDR-TB contributing 2.29 millions DALYs (95% UI: 0.12, 0.53 millions) (Table S4).
In 2021, the age-standardized DALY rate of all HIV-negative TB in males was 705.23 per 100,000 population (95% UI: 623.40, 834.06), with an decline of -0.63% (95% U:I -0.69, -0.47) compared to 1990. For females, the age-standardized DALY rate for all HIV-negative TB was 463.18 per 100,000 population (95% UI: 417.49, 512.9), with an decline of -0.67% (95%UI: -0.71 to -0.63) compared to 1990. In 2021, the age-standardized DALY rate caused by TB was higher in males compared to females. Specifically, the age-standardized DALY rate of DS-TB was higher in males than in females, while the age-standardized DALY rates of MDR-TB and XDR-TB showed no significant differences between males and females. Compared to 1990, the age-standardized DALY rates for TB and DS-TB in both males and females showed a declining trend in 2021, with no difference in the age-standardized DALY rate of decline between male and female. However, the age-standardized DALY rates for MDR-TB increased in both males and females, with no significant difference increase between genders.
The age-standardized DALY rate of TB, DS-TB, and MDR-TB was highest in regions with Low SDI, followed by Low-middle SDI regions. The age-standardized DALY rates of TB and DS-TB in Low SDI areas were significantly higher than in other regions. The age-standardized DALY rate of XDR-TB was highest in Low-middle SDI countries, followed by Low SDI regions. Over the past 30 years, the age-standardized DALY rates of TB and DS-TB have shown a significant declining trend across all five SDI regions. However, the age-standardized DALY rate of MDR-TB has increased in Low-middle SDI and Low SDI regions, while it has shown a significant decrease in High SDI regions and an initial increase followed by a decline in High-middle SDI regions. The age-standardized DALY rate for XDR-TB has decreased in High-middle SDI regions, but there were no significant changes in the other four SDI regions (Table 3, Fig. 3).
In 2021, the age-standardized DALY rates of TB, DS-TB, and MDR-TB were highest in Central Sub-Saharan Africa, followed by Eastern Sub-Saharan Africa and Southern Sub-Saharan Africa. The lowest age-standardized DALY rates for TB and DS-TB were observed in Australasia, while the lowest rates for MDR-TB were in High-income North America. The highest age-standardized DALY rates for XDR-TB were in Southeast Asia, followed by Oceania and Western Europe. Compared to 1990, the age-standardized DALY rates for TB and DS-TB decreased in all 21 regions globally by 2021, with the largest declines observed in High-income Asia Pacific, followed by Andean Latin America and East Asia. The trends for MDR-TB varied across the 21 regions, with the highest increases in age-standardized DALY rates observed in Oceania, followed by Central Asia and South Asia. Increases were also noted in Tropical Latin America, Eastern Sub-Saharan Africa, Eastern Europe, Southern Sub-Saharan Africa, Western Sub-Saharan Africa, and Central Latin America. Conversely, the most significant decreases in MDR-TB-related DALY rates were seen in High-income North America, followed by East Asia, High-income Asia Pacific, Western Europe, and Central Europe.
In 2021, the countries with the highest age-standardized DALY rates for TB were the Central African Republic (9243.75 per 100,000 population [95% UI: 6246.04, 12335.08]), Lesotho (7772.72 per 100,000 population [95% UI: 5196.89, 10011.22]), and Somalia (7691.18 per 100,000 population [95% UI: 4664.62, 13131.82]). The highest age-standardized DALY rates for DS-TB were also observed in the Central African Republic (8957.36 per 100,000 population [95% UI: 6012.69, 12141.22]), Lesotho (7016.62 per 100,000 population [95% UI: 4703.23, 9224.74]), and Somalia (6609.67 per 100,000 population [95% UI: 3723.69, 11318.37]). For MDR-TB, the countries with the highest age-standardized DALY rates were Somalia (1066.78 per 100,000 population [95% UI: 219.93, 3124.42]), Lesotho (745.74 per 100,000 population [95% UI: 173.08, 2097.96]), and Eswatini (619.20 per 100,000 population [95% UI: 127.73, 1575.29]). The highest age-standardized DALY rates for XDR-TB were found in Mongolia (43.31 per 100,000 population [95% UI: 9.55, 109.82]), Tajikistan (38.76 per 100,000 population [95% UI: 13.65, 77.66]), and Turkmenistan (36.73 per 100,000 population [95% UI: 11.87, 75.54]). Compared to 1990, the age-standardized DALY rates of TB in 2021 did not significantly increase globally, with many countries showing a declining trend. However, some countries exhibited substantial changes, such as Lesotho (0.37% [95% UI: -0.14, 1.05]), Zimbabwe (0.34% [95% UI: -0.19, 0.89]), and Ukraine (-0.1% [95% UI: -0.35, 0.20]). The age-standardized DALY rates for DS-TB increased in Zimbabwe (0.95% [95% UI: 0.17, 1.83]) but decreased in other regions. The fastest increases in age-standardized DALY rates for MDR-TB were observed in Somalia (221.08% [95% UI: 29.43, 2763.48]), followed by Djibouti (218.88% [95% UI: 33.93, 2198.73]) and Uzbekistan (131.54% [95% UI: 20.03, 1866.42]).
Table 3
Age-standardized DALY rate of tuberculosis, drug-susceptible tuberculosis, multidrug-resistant tuberculosis, and extensively drug-resistant tuberculosis in HIV-negative individuals in 2021, and percentage change of rates of age-standardised incidence during the 1990–2021 for Global Burden of Disease regions.
Characteristics | All HIV-negative tuberculosis | Drug-susceptible tuberculosis | Multidrug-resistant tuberculosis | Extensively drug-resistant tuberculosis |
DALY rate, 2021 (per 100000 populations) | Percentage change of DALY rate,1990–2021 (95%: UI) | DALY rate, 2021 (per 100000 populations) | Percentage change of DALY rate,1990, 2021 (95%: UI) | DALY rate,2021 (per 100000 populations) | Percentage change of DALY rate,1990, 2021 (95%: UI) | DALY rate,2021 (per 100000 populations) | Percentage change of DALY rate,2010, 2021 (95%: UI) |
Global | 580.26(522.37, 649.82) | -0.65(-0.69, -0.57) | 526.03(457.25, 596.46) | -0.68(-0.72, -0.6) | 50.76(21.28, 99.37) | 2.68(0.53, 7.7) | 0.58(0.19, 1.39) | -0.25(0.47, 0.05) |
Genderl male | 705.23(623.4, 834.06) | -0.63(-0.69, -0.47) | 638.98(541.8, 752.62) | -0.66(-0.72, -0.52) | 61.64(25.73, 120.57) | 2.66(0.48, 8.29) | 4.61(2.1, 8.53) | -0.28(-0.49, 0.01) |
Genderl female | 463.18(417.49, 512.9) | -0.67(-0.71, -0.63) | 420.27(367.8, 475.67) | -0.7(-0.74, -0.65) | 40.52(16.92, 78.63) | 2.66(0.54, 7.56) | 2.39(0.97, 4.5) | -0.17(-0.44, 0.22) |
East Asia | 94.1(79.17, 111.79) | -0.87(-0.9, -0.83) | 86.21(68.45, 105.4) | -0.88(-0.91, -0.83) | 6.68(1.81, 16.83) | -0.83(-0.96, -0.3) | 2.29(0.55, 7.85) | -0.37(-0.76, 0.45) |
Southeast Asia | 895.71(793.04, 1020.93) | -0.7(-0.74, -0.6) | 861.88(753.85, 987.19) | -0.71(-0.75, -0.61) | 28.46(11.07, 60.35) | 1.05(-0.27, 4.92) | 24.86(14.07, 39.55) | -0.28(-0.62, 0.28) |
Oceania | 1260.62(1040.39, 1534.8) | -0.43(-0.59, -0.22) | 1169.03(928.6, 1425.23) | -0.47(-0.62, -0.27) | 77(17.39, 198.67) | 36.35(5.28, 215.45) | 18.96(10.51, 29.19) | 2.19(-0.25, 9.52) |
Central Asia | 221.53(196, 251.98) | -0.64(-0.68, -0.59) | 141.35(100.47, 179.5) | -0.77(-0.83, -0.7) | 55.32(31.87, 85.01) | 26.76(9.54, 80.51) | 3.47(1.51, 6.43) | -0.45(-0.62, -0.26) |
Central Europe | 38.15(34.91, 41.41) | -0.78(-0.79, -0.76) | 36.26(32.74, 39.9) | -0.79(-0.81, -0.77) | 1.31(0.44, 2.88) | -0.35(-0.79, 0.95) | 0.36(0.07, 1.22) | -0.4(-0.8, 0.62) |
Eastern Europe | 133.78(121.2, 147.77) | -0.46(-0.51, -0.41) | 72.33(46.72, 101.88) | -0.7(-0.81, -0.59) | 42.49(24.8, 59.65) | 5.92(1.77, 17.53) | 0.03(0.01, 0.09) | -0.52(-0.67, -0.29) |
High-income Asia Pacific | 23.17(20.77, 25.66) | -0.89(-0.9, -0.87) | 22.61(20.18, 25.1) | -0.89(-0.9, -0.87) | 0.45(0.1, 1.45) | -0.82(-0.97, -0.2) | 0.75(0.21, 2.16) | -0.31(-0.78, 1.08) |
Australasia | 4.25(3.75, 4.81) | -0.74(-0.76, -0.71) | 3.98(3.43, 4.53) | -0.75(-0.78, -0.72) | 0.22(0.07, 0.55) | 0.21(-0.69, 4.15) | 5.2(1.84, 11.92) | 0.65(-0.52, 4.28) |
Western Europe | 7.35(6.71, 8.02) | -0.82(-0.83, -0.81) | 6.99(6.33, 7.66) | -0.83(-0.84, -0.82) | 0.29(0.14, 0.55) | -0.54(-0.74, -0.09) | 14.59(3.29, 39.97) | -0.12(-0.41, 0.39) |
Southern Latin America | 52.94(49.39, 56.77) | -0.76(-0.78, -0.74) | 51.39(47.02, 55.65) | -0.77(-0.79, -0.75) | 1.23(0.26, 3.76) | -0.17(-0.83, 2.62) | 1.21(0.3, 3.13) | -0.04(-0.72, 1.37) |
High-income North America | 4.99(4.62, 5.39) | -0.77(-0.78, -0.76) | 4.83(4.35, 5.22) | -0.77(-0.78, -0.75) | 0.13(0.04, 0.37) | -0.9(-0.96, -0.67) | 5.36(1.92, 12.43) | 0.53(-0.38, 2.91) |
Caribbean | 247.18(168.62, 534.96) | -0.6(-0.71, -0.45) | 244.67(167.68, 529.26) | -0.61(-0.71, -0.45) | 2.15(0.4, 6.66) | -0.49(-0.9, 1.09) | 2.6(1.01, 5.36) | 0.74(-0.49, 0.98) |
Andean Latin America | 262.27(213.74, 326.15) | -0.88(-0.9, -0.84) | 225.48(171.63, 284.34) | -0.89(-0.92, -0.86) | 31.59(11.9, 68.16) | -0.04(-0.66, 2.22) | 1.23(0.39, 2.75) | -0.04(-0.5, 0.82) |
Central Latin America | 88.38(78.7, 100.08) | -0.81(-0.83, -0.78) | 82.86(72.36, 94.81) | -0.82(-0.84, -0.8) | 4.74(1.64, 10.35) | 3.06(0.47, 10.01) | 0.05(0.01, 0.13) | 0.2(-0.38, 1.28) |
Tropical Latin America | 91.92(87.08, 97.23) | -0.72(-0.73, -0.71) | 85.98(73.3, 93.89) | -0.74(-0.78, -0.72) | 5.1(1.02, 14.91) | 14.01(1.2, 114.97) | 0.07(0.03, 0.15) | 0.42(-0.6, 2.71) |
North Africa and Middle East | 154.48(124.84, 212.96) | -0.75(-0.8, -0.66) | 143.76(110.69, 199.33) | -0.77(-0.82, -0.69) | 9.97(3.13, 25) | 2.64(0.24, 10.11) | 0.78(0.27, 1.8) | -0.28(-0.7, 0.76) |
South Asia | 1133.21(1015.74, 1304.29) | -0.72(-0.76, -0.64) | 986.71(766.48, 1170.4) | -0.75(-0.81, -0.68) | 139.31(35.46, 313.45) | 16.45(2.36, 84.88) | 7.19(1.79, 16.99) | 0.12(-0.57, 1.35) |
Central Sub-Saharan Africa | 3530.2(2569.58, 4965.79) | -0.52(-0.63, -0.36) | 3361.35(2444.44, 4756.21) | -0.54(-0.65, -0.39) | 166.56(42.73, 566.43) | 2.8(-0.23, 19.09) | 0.32(0.06, 1.07) | 0.11(-0.62, 2.31) |
Eastern Sub-Saharan Africa | 2538.08(2096.61, 3066.18) | -0.67(-0.72, -0.59) | 2345.73(1904.02, 2864.53) | -0.69(-0.75, -0.61) | 189.74(75.5, 390.11) | 13.44(3.95, 34.66) | 2.35(0.8, 5.57) | 0.28(-0.22, 0.99) |
Southern Sub-Saharan Africa | 2369.82(2080.46, 2768.09) | -0.33(-0.48, -0.19) | 2195.17(1851.87, 2601.57) | -0.37(-0.52, -0.23) | 172.3(63.88, 382.47) | 4.83(0.67, 23.78) | 0.84(0.14, 2.58) | -0.08(-0.57, 1.07) |
Western Sub-Saharan Africa | 1401.6(1096.23, 1729.1) | -0.62(-0.71, -0.49) | 1310.34(1022.21, 1628.52) | -0.64(-0.72, -0.52) | 90.03(31.43, 197.3) | 3.41(0.84, 10.92) | 0.11(0.02, 0.35) | -0.1(-0.52, 0.7) |
High-middle SDI | 87.95(79.1, 100.05) | -0.78(-0.81, -0.72) | 73.19(61.9, 85.61) | -0.81(-0.84, -0.75) | 11.04(6.33, 18.03) | -0.14(-0.67, 1.72) | 3.72(2.06, 5.94) | -0.57(-0.68, -0.41) |
High SDI | 17.78(15.97, 20.38) | -0.82(-0.84, -0.79) | 16.88(14.94, 19.28) | -0.82(-0.84, -0.79) | 0.74(0.31, 1.52) | -0.65(-0.83, -0.29) | 0.15(0.07, 0.3) | -0.32(-0.53, 0.01) |
Low-middle SDI | 1154.27(1020.37, 1300.64) | -0.69(-0.73, -0.6) | 1033.52(854.57, 1189.41) | -0.72(-0.78, -0.64) | 113.99(37.12, 248.83) | 12.94(3.29, 40.89) | 6.76(2.26, 14.63) | 0.05(-0.44, 0.9) |
Low SDI | 1976.06(1708.98, 2309.04) | -0.65(-0.7, -0.56) | 1813.84(1550.67, 2114.12) | -0.68(-0.73, -0.59) | 157.61(66.11, 316.55) | 6.79(2.74, 14.88) | 4.6(1.59, 10.13) | 0.07(-0.44, 1.18) |
Middle SDI | 368.03(332.81, 427.21) | -0.73(-0.76, -0.65) | 337.28(296.19, 391.47) | -0.74(-0.78, -0.67) | 27.94(10.72, 55.83) | 0.11(-0.62, 2.65) | 2.82(1.18, 5.16) | -0.23(-0.52, 0.14) |
Gender and age distribution
In the 80–84 age group and above, the specific incidence rates of TB and DS-TB are higher in males than in females, with no significant differences observed in other age groups. The specific incidence rates for MDR-TB and XDR-TB show no differences between males and females across all age groups (Fig. 4, A-C).
In the 30–34 age group and above, the specific mortality rate of TB is higher in males than in females, with no significant differences in other age groups. In the 25–29 age group and those aged 30 and above, the specific mortality rate of DS-TB is higher in males than in females. The specific mortality rates for MDR-TB and XDR-TB show no differences between males and females across all age groups (Fig. 4, E-G).
In the 25–29 age group and above, the specific DALY rates for TB and DS-TB are higher in males than in females, with no significant differences in other age groups. The specific DALY rates for MDR-TB and XDR-TB show no differences between males and females across all age groups (Fig. 4, H-J).
Association between TB burden and SDI
In 2021, across 204 countries or regions globally, the ASIR, ASRD, and age-standardized DALY rates for TB and DS-TB declined rapidly with increasing SDI. When the SDI exceeded 0.8, these rates for TB and DS-TB leveled off and showed minimal changes (Figure S1 A-G). For MDR-TB, the ASIR, ASRD, and age-standardized DALY rates decreased gradually with rising SDI. However, once the SDI surpassed 0.8, these rates either declined very slowly or remained stable (Figure S2 A-C). In the case of XDR-TB, the ASIR, ASRD, and age-standardized DALY rates initially increased slowly with rising SDI. After the SDI reached 0.75–0.80, the ASIR began to decline rapidly with further increases in SDI. Meanwhile, the ASRD and age-standardized DALY rates for XDR-TB initially increased slowly with rising SDI. Once the SDI reached 0.60–0.65, these rates began to decline rapidly with further increases in SDI (Figure S3 A-C).
From 1990 to 2021, the ASIR, ASDR and age-standardized DALY rates of TB remained stable when the SDI ranged from 0.0 to 0.6, and began to decline as the SDI increased beyond 0.60. The trends varied by region: ASIR of TB in Central Sub-Saharan Africa, Southern Sub-Saharan Africa, and Southeast Asia increased slowly with rising SDI. In contrast, ASDR and age-standardized DALY rates in Central Sub-Saharan Africa and South Asia declined rapidly with increasing SDI (Fig. 5A-C). The patterns for ASDR and age-standardized DALY rates of DS-TB were similar to those for TB across different regions (Fig. 5D-F). ASDR and age-standardized DALY rates of generally rose slowly with increasing SDI within the 0-0.7 range from 1990 to 2021. Beyond an SDI of 0.70, these rates began to decline slowly in Eastern Europe. In South Asia, however, ASIR of MDR-TB continued to rise with increasing SDI, while ASDR and age-standardized DALY rates remained high and stable. In East Asia, Eastern Europe, and Central Sub-Saharan Africa, the ASIR, ASDR and age-standardized DALY rates of MDR-TB initially increased rapidly with rising SDI, peaked, and then declined rapidly as SDI continued to increase (Fig. 5G-I). In addition, XDR-TB ASIR and ASID in Central Sub-Saharan Africa and South Asia showed a rapid upward trend with increasing SDI. In Eastern Europe, Central Asia, and East Asia, ASDR and age-standardized DALY rates of XDR-TB rose rapidly with increasing SDI, peaked, and then declined rapidly with further increases in SDI (Fig. 5J-L).
Risk Factors for TB
From 1990 to 2021, the primary risk factors for the ASDR and age-standardized DALY rate were tobacco use, high fasting plasma glucose, high body-mass index, dietary risks, and low physical activity. Among these, the proportion of ASDR and age-standardized DALY rates attributable to tobacco use has been declining, whereas the proportion attributable to high fasting plasma glucose and high body-mass index has been increasing (Fig. 6A-D). The risk factors and their trends for the ASDR and age-standardized DALY rate of DS-TB and MDR-TB mirrored those for TB (Fig. 6A-D). For XDR-TB, the leading risk factors for ASDR and age-standardized DALY rate were also tobacco use, high fasting plasma glucose, high body-mass index, dietary risks, and low physical activity. However, the contribution of tobacco use to ASDR and age-standardized DALY rate of XDR-TB increased slowly from 1990 to 2005, then declined rapidly thereafter. In contrast, the proportion attributable to high fasting plasma glucose and high body-mass index continued to rise (Fig. 6E, F). The contributions of dietary risks and low physical activity to the ASDR and age-standardized DALY rate of TB, DS-TB, MDR-TB, and XDR-TB have remained relatively stable and low throughout the past thirty years (Fig. 6A-F).