Trend and forecast analysis of the changing disease burden of tuberculosis in China, 1990–2021

Tuberculosis (TB) remains a significant public health concern in China. Using data from the Global Burden of Disease (GBD) study 2021, we analyzed trends in age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years (DALYs) for TB from 1990 to 2021. Over this period, HIV-negative TB showed a marked decline in ASIR (AAPC = -2.34%, 95% CI: -2.39, -2.28) and ASMR (AAPC = -0.56%, 95% CI: -0.62, -0.59). Specifically, drug-susceptible TB (DS-TB) showed reductions in both ASIR and ASMR, while multidrug-resistant TB (MDR-TB) showed slight decreases. Conversely, extensively drug-resistant TB (XDR-TB) exhibited upward trends in both ASIR and ASMR. TB co-infected with HIV (HIV-DS-TB, HIV-MDR-TB, HIV-XDR-TB) showed increasing trends in recent years. The analysis also found an inverse correlation between ASIRs and ASMRs for HIV-negative TB and the Socio-Demographic Index (SDI). Projections from 2022 to 2035 suggest continued increases in ASIR and ASMR for XDR-TB, HIV-DS-TB, HIV-MDR-TB, and HIV-XDR-TB. The rising burden of XDR-TB and HIV-TB co-infections presents ongoing challenges for TB control in China. Targeted prevention and control strategies are urgently needed to mitigate this burden and further reduce TB-related morbidity and mortality.