The burden of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis and its attributable risk factors in 204 countries and territories, 1990–2021

Objective Anti-tuberculosis drug resistance has become a major challenge to global tuberculosis control. This study aims to comprehensively the global burden, trends, and risks for disease deaths of multidrug-resistant tuberculosis (MDR-TB), extensively drug-resistant tuberculosis (XDR-TB), HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB from 1990 to 2021. Methods Data on the incidence and deaths of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB were obtained from GBD 2021. The estimated annual percentage change (EAPC) and fold change were calculated to assess the trends of disease burden changes from baseline (1990 for MDR-TB and HIV/AIDS-MDR-TB; 1993 for XDR-TB and HIV/AIDS-XDR-TB) to 2021. Results In 2021, the highest age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR) were observed in MDR-TB globally, with 5.4161 (3.1676–9.3429) and 1.2791 (0.4992–2.5331) per 100,000 population, respectively. A significant increase in the global incidence and death burden of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB has been reported from baseline to 2021. Especially for HIV/AIDS-XDR-TB, death cases increased 84.89-fold, with an EAPC in ASDR of 10 (6.26–13.86). In contrast, MDR-TB demonstrated a comparatively smaller increase, with death cases rising 5.65-fold and an EAPC in ASDR of 1.18 (−0.37–2.75). Over the past 32 years, the incidence and death ratio of these types of DR-TB in the High-middle SDI region have been the highest. In terms of age patterns, the burden of MDR-TB and XDR-TB has increased most significantly in the 15–49 age group. In contrast, the burden of HIV/AIDS-MDR-TB and HIV/AIDS-XDR-TB has notably increased among those aged 5–14. Conclusion Over the past 30 years, a significant increase in the global burden of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB has been reported, with marked variations in various resistance types across different regions and countries. In particular, the high-middle SDI regions warrant special attention. These findings highlight the need for further research to identify effective intervention strategies tailored to the epidemiological patterns observed in different regions and populations.