Burden of TB, 1990–2050: a comparative analysis of GBD 2021 and WHO surveillance systems

Who

• Population: Global population, stratified by age, sex, Sociodemographic Index (SDI) quintiles, regions, and countries.

• Geographic focus: Worldwide, with detailed analyses for eight high-burden countries (India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh, Democratic Republic of the Congo) plus Hong Kong SAR, Macau SAR, and Taiwan.

• Data sources:

  • World Health Organization – Global Health Observatory (WHO-GHO)

  • Institute for Health Metrics and Evaluation – Global Burden of Disease (GBD 2021)

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What

• Focus: Comprehensive assessment of global tuberculosis (TB) burden and trends, including TB overall, drug-susceptible TB (DS-TB), latent TB infection (LTBI), multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB).

• Key findings:

  • From 1990 to 2021, global age-standardized rates of TB prevalence, incidence, deaths, and DALYs declined substantially.

  • DS-TB mirrored overall TB declines, while MDR-TB and XDR-TB showed earlier peaks followed by plateauing or renewed increases in some settings.

  • LTBI prevalence declined steadily but remained very high globally.

  • Low-SDI regions consistently bore the highest DALY burdens.

  • Smoking, high alcohol consumption, and elevated fasting plasma glucose were the leading modifiable risk factors for TB-related DALYs.

  • Projections to 2050 suggest continued declines overall, but rising XDR-TB incidence and mortality in some regions (notably Indonesia and the Western Pacific).

  • WHO-GHO and GBD 2021 estimates broadly agreed on totals but diverged in rates and stratification, especially in high-burden countries.

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When

• Historical analysis: 1990–2021

• Comparative database analysis: 2000–2021

• Projections: 1990–2050 (GBD 2019 foresight scenarios)

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Where

• Global scope, with regional analyses across 21 GBD regions.

• Country-level analyses for 204 countries/territories, emphasizing high TB burden settings.

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Why

• To address gaps in understanding:

  • Long-term spatiotemporal trends in TB and its subtypes.

  • Geographic hotspots and vulnerable populations.

  • The contribution of modifiable risk factors to TB-related disability.

  • Systematic discrepancies between WHO-GHO and GBD estimates that affect surveillance, policy-making, and health-system planning.

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How

• Study design: Multidimensional secondary data analysis.

• Data sources & tools:

  • GBD 2021 taxonomy and estimates (DisMod-MR 2.1, CODEm).

  • WHO-GHO TB indicators.

  • GBD Compare, Results Tool, and SCImago Graphica.

• Methods:

  • Age-standardized rates for prevalence, incidence, deaths, and DALYs.

  • Comparative risk assessment using population-attributable fractions (PAFs).

  • SDI-stratified analyses.

  • Joinpoint (linkage-point) regression for trend detection and APC estimation.

  • LOESS smoothing for WHO–GBD trajectory comparisons.

• Outputs: Global, regional, and national trend analyses; risk-factor attribution; future projections; and cross-database concordance assessment.

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Overall interpretation:
The study demonstrates substantial global progress against TB since 1990, but highlights persistent inequities, emerging threats from drug-resistant TB, and important methodological differences between global data systems, underscoring the need for targeted prevention, risk-factor modification, and harmonized surveillance.

Source: Jiang, F., Li, X., Qiao, Q., Zhang, M., Tian, Y., Zhou, S., Li, Y., Ni, R., Liu, Y., Zhang, L. and Gong, W., 2026. Global, regional, and national burden of tuberculosis, 1990–2050: a systematic comparative analysis based on retrospective cross-sectional of GBD 2021 and WHO surveillance systems. International Journal of Surgery, 112(1), pp.250-269.