The epidemiology of tuberculosis infection and the Human Development Index (HDI) in Iran between 1990–2021: secondary analysis of the global burden of disease

This ecological study examines epidemiological trends in tuberculosis, multidrug-resistant TB, extensively drug-resistant TB, and latent TB infection across Iran and its provinces from 1990 to 2021, and explores their association with the Human Development Index. Data from the Global Burden of Disease 2021 study, were used to assess the incidence, mortality, and prevalence of tuberculosis, multidrug-resistant tuberculosis, extensively drug-resistant tuberculosis, and latent tuberculosis infection at both national and provincial levels in Iran. The association between tuberculosis indicators and the Human Development Index was evaluated using bivariate correlation analysis, with P < 0.05 considered statistically significant. Geographic maps illustrating the spatial distribution of the disease across provinces were generated using Arc-GIS 10.8.2 software. All statistical analyses were performed using Stata version 12 (Stata Corp, College Station, TX, USA). The age-standardized incidence rate (ASIR) of tuberculosis decreased from 22.60 cases per 100,000 population (95% CI: 20.09–25.41) in 1990 to 13.51 cases (95% CI: 11.98–15.15) in 2021. The average annual percent change was: − 0.40 (95% CI: − 0.43 to − 0.37). In 2021, the age-standardized mortality rate was 1.09 cases per 100,000 (95% CI: 0.92–1.30), with an average annual percent change: − 0.73; (95% CI: − 0.80 to − 0.57). Sistan and Baluchistan (32.21 per 100,000) and Golestan (24.46 per 100,000) reported the highest incidence rates, whereas Chahar Mahaal and Bakhtiari (3.08 per 100,000) and Isfahan (6.71 per 100,000) reported the lowest. A significant inverse correlation was observed between the Human Development Index and tuberculosis indicators (P < 0.05). The prevalence of multidrug-resistant tuberculosis was 1.7%, and the prevalence of latent tuberculosis infection was 25,027 cases per 100,000 population. Substantial progress has been made in reducing the tuberculosis burden in Iran. Nevertheless, marked regional disparities and persistent challenges related to multidrug-resistant tuberculosis and latent TB infection highlight the need for targeted interventions, including enhanced screening, improved diagnostic capacity, and expanded preventive treatment strategies.