Global Burden of Tuberculosis From 1990 to 2019

Abstract Background Tuberculosis is the most pervasive infectious diseases worldwide. Studies examining the scope, variation and influence factor of the worldwide burden of tuberculosis are lacking. Methods In this cross-sectional study, epidemiologic data were gathered using the Global Health Data Exchange query tool, covering persons with tuberculosis in 204 countries and 21 regions from January 1, 1990, to December 31, 2019. We estimated the incidence and age-standardized rates (ASR) on tuberculosis by age, sex, region, and country. Annual percentage change (EAPC) was used to quantify the temporal trends of ASR. We also analyzed the incidence, mortality and variation trends and influence factor of tuberculosis including drug-susceptible and drug-resistant tuberculosis from 1990 to 2019. Results Globally, the incident cases of tuberculosis had decreased in most part of the world from 1990 to 2019, the age-standardized incidence rates (ASIR) decreased by an average 1.63% per year. Central and Southern Sub-Saharan Africa had the highest ASIR in 2019. Globally, the number of incidents mainly appeared in 20–24 years old individuals in both genders. Nearly half of all new cases of drug-susceptible tuberculosis (DS-TB) and multidrug-resistant tuberculosis without extensive drug resistance (MDR-TB) in 2019 came from South Asia, the proportion had already exceeded nearly 50% globally. By contrast, the most incident cases of extensively drug-resistant tuberculosis (XDR-TB) were found in Eastern Europe. As for various SDI quintiles, the high-middle SDI quintile had a highest ASIR in XDR-TB. As for morality and DALYs, South Asia had the most deaths and DALYs. The change trends of ASDR (age-standardized deaths rate) and age-standardized DALYs rate for DS-TB, MDR-TB and XDR-TB among SDI quintiles showed the same pattern as that in ASIR. We also found an overall inverse association between the ASIR of tuberculosis (and the proportion of drug-resistant tuberculosis) and SDI at the regional level. Conclusion Tuberculosis remained the leading cause of death from an infectious disease worldwide, and the increasing proportion of drug-resistant tuberculosis was of equal concern. The observed regional patterns varied widely, and the geographic disparities may provide support for tuberculosis health care planning and resource allocation.