Global, regional, and national burden of HIV-negative tuberculosis, 1990–2021: Findings from the Global Burden of Disease 2021 Study

Abstract Background Tuberculosis (TB) is an infectious disease primarily caused by the inhalation of Mycobacterium tuberculosis(Mtb). Its widespread transmission, lengthy treatment duration, significant side effects, and high mortality rate severely impact public health. The study presents the epidemiological characteristics of TB globally and in major regions, aiming to reveal the current global and national TB-related disease burdens and provide scientific references for TB prevention and control worldwide. Methods The ecological and time series study utilizes data from the Global Burden of Disease Study 2021. It includes the number of new incidence cases, deaths, disability-adjusted life years (DALYs), and trends in age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and age-standardized DALY rates for drug-susceptible tuberculosis (DS-TB), multidrug-resistant tuberculosis without extensive drug resistance (MDR-TB), and extensively drug-resistant tuberculosis (XDR-TB) from 1990 to 2021. The study analyzes trends of TB, DS-TB, MDR-TB, and XDR-TB across different age groups, genders, main regions, and nations. Additionally, the relationship between the global TB burden and the Sociodemographic Index (SDI) was explored using a general generalized linear regression model. Results In 2021, the global ASIR for all HIV-negative TB was 103.00 per 100,000 population (95% uncertainty interval UI: 92.21, 114.91), with an declining by -0.40% (95%UI: -0.43, -0.38) compared to 1990. The global ASDR of TB was 13.96 per 100,000 population (95%UI: 12.61, 15.72), with an declining by-0.44% (95%UI: -0.61, -0.23) compared to 1990. The global age-standardized DALY rate for HIV-negative TB was estimated at 580.26 per 100,000 population (95%UI: 522.37, 649.82), with an declining by -0.65% (95%UI: -0.69 to -0.57) compared to 1990. Globally, significant declines in the ASIR, ASDR, and the age-standardized DALY rate for TB, DS-TB, and the MDR-TB were observed only when the SDI exceeded. The contribution of tobacco use to the ASIR, ASDR and age-standardized DALY rate of TB, DS-TB, and MDR-TB has been decreasing. In contrast, the impact of high fasting plasma glucose and high body mass index on the ASIR and ASDR of TB, DS-TB, and MDR-TB has been increasing. Conclusions MDR-TB and XDR-TB continues to impose a significant health burden, particularly in regions with low SDI. Developing effective, sensitive, accurate, rapid, and convenient Mtb screening technologies, along with novel anti-TB drugs of shorter treatment durations, is crucial. Continuous optimization, updating, and promotion of new TB treatment regimens and scheme are essential for reducing the TB burden.