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.