Epidemiological mapping of drug-susceptible and resistant tuberculosis in 30 WHO high-burden countries: Three decades of GBD 2023 trends, projections to 2043 and concordance with WHO estimates.

OBJECTIVES

Tuberculosis (TB) continues to drive infectious mortality worldwide. The study characterized the evolution of drug-susceptible TB (DS-TB), multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB) in 30 WHO high-burden countries, linking current patterns to long-term trends, age structure, and forward-looking scenarios to 2043.

METHODS

Using GBD 2023 estimates for 1990-2023, we extracted incidence, mortality, and DALYs as age-standardized rates (ASR) per 100,000 with 95% uncertainty intervals. Temporal dynamics were summarized with Estimated Annual Percent Change (EAPC) and extended linearly to 2043. GBD incidence and mortality were compared against WHO national TB series for 2010-2023.

RESULTS

Overall TB incidence ASR declined in 28/30 countries between 1990 and 2023, ranging from a 79.2% reduction in Bangladesh to a 24.9% increase in the Philippines. Mortality and DALY ASR decreased in 29/30 countries. DS-TB incidence dropped in 28/30 settings, while MDR-TB incidence rose in 28/30, from -62.5% in China to +23,603% in Kyrgyzstan. The MDR/RR-TB burden shifted toward older adults (≥55 years) in countries such as China (+22 percentage points), whereas youth contributions remained high in Nigeria (~40%). Projections assuming constant EAPC suggest continued DS-TB declines but sustained MDR-TB in Eastern Europe and Central Asia.

CONCLUSION

The MDR-TB remains concentrated and often increasing with limited detectable XDR-TB. Age-tailored interventions, universal drug-susceptibility testing, scale-up of all-oral second-line regimens, and adherence support are critical to reverse resistant-TB trajectories while preserving gains against DS-TB.