ArticleJournal of clinical tuberculosis and other mycobacterial diseases2026
Epidemiologic trajectories and burden of multidrug-resistant tuberculosis (MDR-TB) mortality across South Asia: An analysis of Global Burden of Disease data (1990-2023) with machine learning forecasting to 2050.
Article in Journal of clinical tuberculosis and other mycobacterial diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge in South Asia, which bears a disproportionate global burden. Comprehensive, longitudinal analyses of MDR-TB mortality trends, stratified by country and sex, with forward-looking projections are limited. Methods: We conducted a retrospective analysis using data from the Global Burden of Disease Study 2023 to examine age-standardized mortality rates (ASMR) attributable to MDR-TB in South Asia and its countries (Bangladesh, Bhutan, India, Nepal, Pakistan) from 1990 to 2023. Trends were assessed by sex, and estimated annual percentage changes (EAPC) were calculated via log-linear regression. Seasonal Autoregressive Integrated Moving Average (SARIMA) models were employed to forecast ASMR through 2050, with 95% prediction intervals. Results: Regional ASMR rose from 0.25 per 100,000 (95% UI: 0.03-0.88) in 1990 to a peak of 6.34 (95% UI: 2.56-13.56) in 2010, declining to 3.63 (95% UI: 0.54-9.80) by 2023, driven predominantly by India and Pakistan. Nepal exhibited consistent declines (EAPC: -2.44%; 95% CI: -3.21 to -1.66), while Pakistan showed the highest increase (EAPC: 6.16%; 95% CI: 3.21-9.19). Males consistently had higher ASMR across all settings. Forecasts suggest continued declines toward near-elimination in Bangladesh, Bhutan, and Nepal, but potential substantial rebounds in India, Pakistan, and regionally, with upper prediction intervals exceeding 20-40 per 100,000 by 2050 in high-burden scenarios. Conclusion: Despite progress in some countries, MDR-TB mortality remains elevated in populous nations, with persistent male excess. Projections highlight risks of resurgence without intensified interventions. These findings underscore the urgent need for tailored, gender-sensitive strategies and enhanced regional collaboration to achieve End TB targets in South Asia.
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