Global, regional, and national burden of tuberculosis, 1990-2050: a systematic comparative analysis based on retrospective cross-sectional of GBD 2021 and WHO surveillance systems

Background Tuberculosis (TB) persists as a leading global health threat. Current surveillance is fragmented, and the surgical burden of drug-resistant forms remains poorly quantified. Methods Using GBD 2021 (1990-2050) and WHO-GHO (2000-2021), we estimated mortality, incidence, prevalence, and disability-adjusted life years (DALYs) for 204 countries by age, sex, and four TB subtypes: latent tuberculosis infection (LTBI), drug-susceptible tuberculosis (DS-TB), multidrug-resistant tuberculosis (MDR-TB), and extensively drug-resistant tuberculosis (XDR-TB). We compared WHO and GBD figures in eight high-burden countries, applied joinpoint regression to project trends, and quantified risk-factor contributions. Results In 2021, global TB rates per 100,000 were: prevalence 236.14 (95% UI 214.51-260.20), incidence 103.00 (92.21-114.91), deaths 13.96 (12.61-15.72), and DALYs 580.26 (522.37-649.82). Sociodemographic index (SDI) gradients were steepest for XDR-TB. Smoking, high alcohol use and elevated fasting glucose explained >0.1% of DS-TB DALYs each. WHO-GBD mortality diverged in Bangladesh, Nigeria, and the Democratic Republic of the Congo; incidence differed markedly in Indonesia and the Philippines. Projections indicate rising mortality after 2030 in Indonesia and the Western Pacific under high-risk scenarios. Conclusions XDR-TB is emerging as the fastest-growing threat. Discrepancies between WHO and GBD compromise resource allocation; harmonisation is urgently needed, especially for surgical services planning in Indonesia and the Western Pacific.