Abstract Introduction Tuberculosis (TB) remains a global health concern despite two decades of coordinated elimination efforts. The uneven decline across regions implies that biological, demographic, and health-system factors collectively shape transmission dynamics. This study evaluates global TB incidence trends from 2001 to 2023, emphasizing sex-specific differences and regional variability that may signal emerging resistance or inequitable progress in control measures. Methods Data were obtained from the Global Burden of Disease (GBD) database for 2001–2023 and analyzed using Microsoft Excel. Annual incidence proportions were stratified by sex and world region. For each subgroup, mean incidence, annual change, and Average Percent Change (APC) were calculated. Regions with plateauing or rising incidence were compared with areas historically associated with multidrug-resistant tuberculosis (MDR-TB) to explore epidemiologic overlap. Results Global TB incidence changed minimally from 0.0338% in 2001 to 0.039% in 2023, corresponding to an overall APC of + 0.64%, reflecting stagnation rather than decline. Males demonstrated persistently higher incidence (0.0385% → 0.043%; APC +0.49%) than females (0.0283% → 0.034%; APC +0.91%). The lowest mean rates occurred in Australasia and high-income Asia Pacific (0.001%), suggesting near-elimination. Central Asia recorded the highest mean incidence (male 0.0182%, female 0.0091%) with a marked sex gap (∼0.009%). Eastern Europe experienced initial reductions followed by stabilization, while Sub-Saharan Africa and Southeast Asia displayed rising trends after 2015, aligning with known MDR-TB hotspots. Discussion The plateau in global incidence highlights the limits of conventional TB control strategies in certain settings. The persistent male predominance likely stems from greater occupational exposure, higher smoking prevalence, and delayed presentation for care. Areas with resurging incidence—particularly in Africa and Asia—correlate with limited diagnostic capacity, inconsistent drug-sensitivity testing, and socioeconomic instability. The gradual rise among females may reflect improved reporting systems rather than increased biologic vulnerability. Moreover, nations affected by conflict or fragile economies showed delayed improvement, underscoring the dependence of TB control on robust healthcare infrastructure. Co-endemic HIV infection may further perpetuate transmission in high-burden regions. Conclusions Between 2001 and 2023, global TB incidence exhibited minimal progress toward elimination, with substantial geographic and gender disparities. High-income nations approach eradication, whereas Africa and Asia face stagnating or worsening trends, largely driven by resistance, diagnostic inequities, and system fragility. Renewed global commitment—centered on rapid resistance testing, equitable surveillance, and context-specific interventions—is essential to sustain momentum toward TB eradication. This abstract is funded by: None
Jagra et al. (Fri,) studied this question.