Long-Term Tuberculosis Mortality Trends in Kazakhstan, 1998–2024: Regional Inequalities, Associated Factors and Health System Reforms

Background: Tuberculosis (TB) mortality remains an important indicator of disease burden, health system performance, and progress toward global TB control targets. This study aimed to assess long-term trends in TB mortality in Kazakhstan from 1998 to 2024 and to examine regional differences and population-level factors associated with mortality. Methods: A retrospective descriptive study with a documentary analysis component was conducted using official national statistical data. TB mortality rates were analyzed at the national and regional levels, and associations with health system indicators, clinical TB characteristics, and population health factors were assessed using correlation and regression analyses. Results: TB mortality in Kazakhstan declined from 38.4 per 100,000 population in 1998 to 1.0 per 100,000 in 2024, corresponding to an overall reduction of approximately 97.4%. Despite this marked decline, regional differences persisted. The steepest reductions were observed in Mangystau (AAPC −16.38%), Aktobe (−15.65%), and Pavlodar (−15.28%) regions. By 2024, mortality was below 3 per 100,000 nationwide, although East Kazakhstan, Karagandy, West Kazakhstan, and North Kazakhstan retained comparatively higher rates. TB mortality was negatively associated with the number of physicians and positively associated with hospital service utilization indicators, the proportion of fibrocavitary TB among newly registered cases, and alcohol dependence. Conclusions: The long-term decline in TB mortality coincided with major national TB control reforms, including the expansion of DOTS/DOTS-Plus, wider access to rapid molecular diagnostics, and the introduction of all-oral treatment for drug-resistant TB. Further efforts are warranted to reduce persistent regional disparities and sustain progress in TB mortality reduction.