Applying Multiple Analyses to Quantify Changes in the Global, Regional, and National Burden of Tuberculosis From 1990 to 2021 and the Forecast Until 2035

Background Comprehensive assessments of changes in the burden of tuberculosis (TB) can inform health strategies. Methods Disability-adjusted life years (DALYs) data were obtained from the Global Burden of Disease database. We used estimated annual percentage changes (EAPCs) to evaluate trends; decomposition analysis to examine the effects of population growth, aging, and epidemiological changes; age-period-cohort model to measure the age, period, and cohort effect; health inequality analysis to assess absolute and relative inequalities; frontier analysis to explore the lowest potential achievable burden based on sociodemographic index (SDI); and Bayesian age-period-cohort model to project future trends. Results Central Asia (EAPC, 7.82, 95% confidence interval [CI], 6.24-9.43) and Eastern Europe (EAPC, 9.42, 95% CI, 7.33-11.55) had notable increases in TB-related DALYs from 1990 to 1999. Globally, the contributions of population aging, growth, and epidemiological change of TB burden from 1990 to 2021 were -17.29%, -77.75%, and 195.04%, respectively. Children aged 0-4 years have an extremely high risk of TB-related DALYs. Period and cohort effects of TB continuously declined. The slope index of inequality increased from -5183.27 (95% CI, -5636.08 to -4730.46) in 1990 to -1729.88 (95% CI, -1927.35 to -1532.41) in 2021, suggesting a reduction in absolute socioeconomic inequality. Nevertheless, the concentration index showed a minimal decrease from -0.516 (95% CI, -0.571 to -0.461) in 1990 to -0.532 (95% CI, -0.603 to -0.461) in 2021, indicating an increase in relative socioeconomic inequality. Most regions have substantial potential to reduce their TB burden, with the Central African Republic having the highest potential. For low-SDI countries, Niger may serve as an exemplar, and poverty elimination could have profound effects. The burden of TB is projected to decline, but it is unlikely to meet the goals of the End TB Strategy. Conclusion TB continues to pose a critical health challenge that necessitates the implementation of effective control strategies.