The global, regional, and national burden of tuberculosis in 204 countries and territories, 1990–2019

Abstracts: Background: Tuberculosis (TB) is the leading cause of death from a single infectious disease and ranks 13th among the leading causes of death worldwide. In this study, we aimed to report the burden of TB in 204 countries and territories from 1990 to 2019 by sex, age, and socio-demographic index (SDI). Methods: Annual death number, age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life year (DALY) rates (ASDR) with a 95% uncertainty interval (UI) of TB were derived from the global burden of disease (GBD) 2019 for the time period between 1990 and 2019. The association between the burden of TB and SDI was also investigated. Results: The total death number related to TB decreased by 33.6%, from 1777.5 in 1990–1179.8 in 2019, per 1000 individuals. The global ASMR and ASDR for TB were 14.64 (13.39–16.03) and 590.42 (536.85–646.42), which were 63.5% and 62.8% lower than in 1990, respectively. South Asia, Eastern Sub-Saharan Africa, Southeast Asia, and Western Sub-Saharan Africa had the largest number of TB deaths in 2019. Central Sub-Saharan Africa was the region with the highest ASMR and ASDR in 2019. India had the highest number of TB deaths, and the Central African Republic and Switzerland had the highest and lowest ASMR per 100,000 individuals, respectively. The number of deaths and DALYs were higher in males than in females and the ASDR significantly increased from the 10–14-year-old age group to the 80–84-year-old age group in both sexes. Most cases of TB were caused by drug-susceptible TB. A negative association between the regional SDI and the ASDR of TB was found. Conclusions: From 1990–2019, TB death number, ASMR, and ASDR decreased. It is important to note that, despite the decreasing burden of TB, it remains a major public health problem, especially in low SDI countries. It is necessary to design and implement suitable strategies to address the current situation.