Global prevalence of tuberculosis and drug-resistant forms: A 30-year analysis from 1990 to 2019

• Global TB prevalence decreasing, but MDRTB and XDRTB rates sharply rising. • In-depth 204-country analysis unveils TB trends & drug resistance rise. • MDRTB rates increasing by 6.008% annually; XDRTB up 71.746%. • Health disparities tied to gender and socioeconomic development. • Urgent actions needed for targeted strategies and elimination goals. Tuberculosis (TB) remains a major global health threat. Multidrug-resistant (MDRTB) and extensively drug-resistant TB (XDRTB) present growing challenges. This study aims to analyze the global and national prevalence trends of TB and its subtypes from 1990 to 2019. This study utilised Global Burden of Disease data to analyse age-standardised prevalence rates (ASPR) and evaluate the global and national prevalence trends of TB and its subtypes from 1990 to 2019. Global TB prevalence is declining but MDRTB and XDRTB are rising sharply. In 2019, TB ASPR was 23 085 per 100 000, falling 1.044% annually since 1990. Latent TB infection decreased 1.044% yearly to 22 906 per 100 000 in 2019. Drug-susceptible TB fell 1.692% annually to 169 per 100 000 in 2019. MDRTB rose 6.008% yearly, reaching 8.6 per 100 000 in 2019. XDRTB increased 71.746% yearly to 0.4 per 100 000. Rates varied widely between countries. ASPR tended to be higher in males and poorer regions. Pace of change differed by sex, socioeconomics and geography. Substantial variations exist in TB prevalence and trends globally, reflecting inequities. Findings provide comprehensive long-term TB assessments, with rising multidrug resistance threatening progress and elimination goals. Urgent targeted strategies are needed for high-risk groups, surveillance, resources, commitment and political will, especially in disadvantaged populations.