Global, Regional, and National Burden and Trends of Tuberculosis Among Children and Adolescents From 1990 to 2021: A Comparative Analysis of Drug-Susceptible and Multidrug-Resistant Tuberculosis With Projections to 2045

Objective To assess the global, regional, and national burden of pulmonary tuberculosis (TB), including drug-susceptible (DS-TB) and multidrug-resistant TB (MDR-TB), among children and adolescents from 1990 to 2021, and to project trends to 2045. Methods Data were extracted from the Global Burden of Disease Study 2021. Age-specific incidence rates (ASIRs) were estimated using DisMod-MR 2.1, and temporal trends were evaluated using estimated annual percentage change (EAPC). Correlation analyses between ASIR and Sociodemographic Index (SDI) were conducted. A Bayesian age-period-cohort model was used to forecast incidence through 2045. Results From 1990 to 2021, global tuberculosis cases in this population declined by 37.4%, while MDR-TB increased by 386.9%. Age-specific incidence rates of tuberculosis and DS-TB declined (EAPC = -2.00 and -2.10), whereas the MDR-TB age-specific incidence rate rose (EAPC = 4.50). The highest ASIRs were observed in sub-Saharan Africa and South Asia. MDR-TB incidence was highest in Eswatini, Namibia, and Lesotho. Incidence increased with age and was consistently higher among males in adolescence. Age-specific incidence rates negatively correlated with SDI across tuberculosis types. Projections indicate a further decline in tuberculosis and DS-TB by 2045, but a continued rise in MDR-TB. Conclusion Despite progress in reducing DS-TB, the rising burden of MDR-TB among children and adolescents remains a major concern, especially in low-SDI regions. Targeted surveillance, gender-sensitive interventions, and equitable access to diagnostics and treatment are essential to address disparities and reduce the tuberculosis burden in young populations.