Tuberculosis disease burden trends, drivers, and projections to 2050 in China and the wider Central Asian region, 1990–2023

Background Tuberculosis (TB) remains a leading infectious killer, with high burden concentrated in China and wider Central Asia. Integrated long-term trend analysis and forecasting for this region are scarce. We aimed to quantify TB burden trends, drivers, inequalities, and 2050 projections across China and wider Central Asia (1990–2023). Methods We used Global Burden of Disease 2023 data to estimate age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint, age-period-cohort, decomposition, and Bayesian APC models were applied. Socioeconomic inequalities were assessed via Socio-demographic Index (SDI) and Concentration Index. Results China achieved steep declines in age-standardized mortality (−94.2%) and DALYs (−92.4%), driven by epidemiological gains offsetting population growth and aging. Central Asia improved moderately but heterogeneously; population growth diluted gains, with Tajikistan showing rising absolute burden. TB burden correlated negatively with SDI; socioeconomic inequality fell markedly, especially for mortality (−69.0%), but persisted among low-SDI groups. By 2050, model projections suggest that mortality targets may be achievable under current trends, although uncertainty remains substantial. Conclusions China has undergone a substantial TB epidemiological transition characterized by marked declines in mortality and DALYs. Targeted interventions-latent TB treatment in China, accelerated case finding and cross-border collaboration in Central Asia-and strengthened regional cooperation are critical to advance regional TB elimination.