Evolving dynamics of tuberculosis and emerging HIV Co-infection in China: Age-period-cohort analysis and projections to 2035

BACKGROUND: Despite significant progress in tuberculosis (TB) prevention, China remains the third-highest TB burdened country globally, with ongoing concerns about drug-resistant tuberculosis (DR-TB) and HIV/TB co-infection. METHOD: The study utilized data from the Global Burden of Disease (GBD) 2021, applying the Age-Period-Cohort (APC) model to analyze age, period, and cohort effects on the incidence and mortality of TB, DR-TB, and HIV/TB co-infection. The Bayesian Age-Period-Cohort (BAPC) model projected future trends from 2022 to 2035. RESULT: Age effects indicated an increased incidence and mortality risk for TB and DR-TB with age, while younger and middle-aged groups were more affected by HIV/TB co-infection. Period effects demonstrated decreasing risks for TB and DR-TB, but an increasing trend for HIV/TB co-infection. Cohort effects similarly indicated a decline for TB and DR-TB, with a slight rise for HIV/TB co-infection among individuals born between 1990 and 2006. BAPC projections indicate that by 2035, the age-standardized incidence rate (ASIR) for TB, DR-TB, and HIV/TB co-infection will be 21.86, 1.04, and 1.21 per 100,000 person-years, respectively, while the age-standardized mortality rate (ASMR) will be 0.90, 0.09, and 0.12 per 100,000 person-years, respectively. None of these projections fulfill the End TB targets. CONCLUSION: Current strategies are unlikely to meet the End TB targets by 2035 in China, suggesting a need for preventive treatment for latent tuberculosis infection (LTBI) and improved screening for HIV and TB in high-risk populations.