Global, regional, and national disease burden of multidrug-resistant tuberculosis without extensive drug resistance, 1990–2021: Findings from the Global Burden of Disease Study 2021

OBJECTIVE: Utilizing Global Burden of Disease Study (GBD 2021) data, this study aims to illustrate trends and spatiotemporal patterns of multidrug-resistant tuberculosis (MDR-TB) burden from 1990 to 2021, and explore their potential mechanisms. METHODS: This research extracted core indicators including incidence, mortality, prevalence, and disability-adjusted life years (DALYs), with their age-standardized rate (ASR). Joinpoint regression, age-period-cohort analysis, inequality analysis, and frontier analysis were applied to describe the temporal and spatial trends of the disease burden. Decomposition analysis and risk factor analysis were performed to explore factors associated with MDR-TB burden fluctuation. Bayesian Age-Period-Cohort (BAPC) model was used to project the disease burden till 2050. RESULTS: Global MDR-TB cases and ASRs of all indicators rose from 1990 to 2021, with heavier burden in older populations and lower socioeconomic regions. Cross-country inequality widened over time. Frontier analysis identified countries including India and Russia with considerable potential for improvement in disease control. Decomposition analysis uncovered epidemiological changes as the main driver of the growing burden globally. Risk factors of MDR-TB in different regions and age groups were heterogeneous. The numbers and ASRs of all indicators are predicted to increase by 2050. CONCLUSIONS: This study revealed that the global disease burden of MDR-TB increased from 1990 to 2021 and is predicted to grow till 2050. Disparities among different social-demographic regions were remarkable and extended over time. Epidemiological changes contributed most to the escalated disease burden. Targeted public health strategies should be adopted for patients in specific regions and age groups.