ArticleBMC infectious diseases2025
Analysis of the disease burden and attributable risk factors of tuberculosis in G20 countries from 1990 to 2021.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Edentulism in China and the Group of Twenty (G20): Epidemiological Trends, Decomposition Analysis, and Forecasts to 2038.International dental journal · 2026Article
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Abstract
objectiveTuberculosis (TB) remains a leading global cause of death attributable to a single infectious agent. However, studies examining the TB burden in The Group of Twenty(G20) countries are limited. This study sought to analyze temporal trends in TB burden and identify key risk factors across G20 nations from 1990 to 2021, while projecting the risk factors-attributable disease burden through 2035 using advanced modeling techniques.
methodsData were obtained from the Global Burden of Disease (GBD) 2021 database. Disease burden was assessed using the disability-adjusted life years (DALYs) and the age-standardized DALYs rates (ASDR), characterizing temporal trends, regional variations, age-specific patterns, and sex disparities in TB burden across G20 countries. Joinpoint regression analysis identified periods with significant temporal changes in country-specific TB ASDR attributable to different risk factors (1990-2021). Health inequality analysis was performed to assess inequalities in TB burden attributable to risk factors relative to the socio-demographic index (SDI). Decomposition analysis was performed to investigate the drivers of changes in TB burden across G20 countries. Additionally, trends in the population attributable fractions (PAF) and summary exposure values (SEV) were analyzed for each risk factor. Finally, Bayesian age-period-cohort (BAPC) modeling was used to project DALYs and ASDR for TB related to six risk factors across the G20 countries from 2022 to 2035.
resultsFrom 1990 to 2021, overall TB DALYs in G20 countries decreased by 50% (95% UI: 36% - 56%). In 2021, India recorded the highest DALYs, followed by Indonesia, while South Africa exhibited the highest ASDR, with Indonesia and India ranking second and third, respectively. Smoking constituted the leading risk factor for TB ASDR in 2021, followed by high alcohol use. Over the past three decades, the PAF of TB DALYs attributable to each risk factor varied significantly across age and gender groups. Health inequality analysis revealed narrowed absolute disparities but widespread exacerbation of relative inequalities in TB burden related to risk factrs across G20 nations. Decomposition analysis demonstrated divergent proportional contributions of drivers-aging, population growth, and epidemiological changes-to the risk-attributable TB burden across G20 countries. BAPC model projections indicated persistently high TB burdens in India, Indonesia, China, and South Africa throgh 2035. Trends in TB DALYs and ASDR attributable to risk factors across G20 countries were heterogeneous: while most nations showed declining smoking-attributable burdens relative to 2021 levels, other risk factors contributed to increased burdens to varying degrees in numerous countries.
conclusionDespite declining TB burden across G20 nations, substantial heterogeneity persists. Smoking and high alcohol use remained the dominant risk factors contributing to TB burden, while comorbidities like diabetes and obesity warrant continued focus. The implementation of interventions specifically targeting these risk factors, combined with enhanced collaborative frameworks within the G20, is essential to further mitigate TB burden and disparities.
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