Global, Regional, and National Burden of Tuberculosis Among Children: A Population-Based Study

<b>Background:</b> Tuberculosis remains a major global public health challenge, particularly among children. This study aims to provide a comprehensive assessment of the global, regional, and national burden of tuberculosis among children (0-14 years) using data from the Global Burden of Disease (GBD) 2021 study. <b>Methods:</b> Data on the incidence of tuberculosis (drug-susceptible, MDR-TB, and XDR-TB), as well as disability-adjusted life years (DALYs), among children aged 0-14 years in 204 countries and territories from 1990 to 2021 were obtained from the GBD 2021 study. Estimated annual percentage changes (EAPCs) in age-standardised incidence rates (ASIRs) and DALY rate were calculated overall and stratified by age, sex, and sociodemographic index (SDI) to quantify temporal trends. Spearman correlation analyses were performed to assess associations between tuberculosis burden and SDI. <b>Results:</b> In 2021, there were an estimated 759,300 new tuberculosis cases (ASIR: 37.7 per 100,000 population) among children globally, including 32,515 cases of MDR-TB (ASIR: 1.6) and 1193 cases of XDR-TB (ASIR: 0.1). Both global ASIR and DALY rate exhibited a declining trend from 1990 to 2021, with EAPC of -2.61% (95%CI: -2.74 to -2.47) and -4.38% (-4.61 to -4.14), respectively. From 1990 to 2021, High-income North America was the only GBD region with an increasing ASIR for tuberculosis (EAPC = 1.12, 95% CI: 0.61 to 1.64). From 1990 to 2021, there was no significant change in ASIR of MDR-TB (EAPC = 1.18, 95% CI: -0.16 to 2.54). However, eight of the 21 GBD regions exhibited increasing trends in the ASIR of MDR-TB, with the largest increase observed in Oceania (11.99, 10.49 to 13.52), followed by Central Asia (9.76, 6.48 to 13.13) and South Asia (5.71, 3.10 to 8.38). A strong negative correlation was observed between tuberculosis burden and SDI, with the highest disease burden concentrated in low-SDI regions. <b>Conclusions:</b> Achieving elimination targets will require stronger diagnostics and treatment for childhood tuberculosis, alongside reduced transmission, improved infection detection, and preventive therapy for exposed children, especially those under 5 years.