Global disease and economic burden of main mycobacterial infections in the working-age population from 1990 to 2021 with a forecast to 2045.

Background: Mycobacterial infections such as tuberculosis and leprosy pose significant global health challenges, particularly in impoverished regions. These diseases not only cause severe physical symptoms but also lead to psychological and economic burdens. This study assesses the disease and economic burden of these infections among the global working-age population (15-64 years), identifies influencing factors, and predicts trends until 2045 to guide targeted interventions. Methods: Using data from the Global Burden of Disease Study (1990-2021), age-standardized prevalence rates and disability-adjusted life years were analyzed for tuberculosis and leprosy. Predictive trends were modeled using the Bayesian age-period-cohort framework, and health inequalities were evaluated using concentration indices. Spearman correlation analysis was used to examine associations with economic and health indicators in the World Bank database. Results: The prevalence of leprosy declined globally (from 14.426/100,000 to 5.942/100,000), and further reductions were projected. Tuberculosis trends were more complex, with potential increases observed in some age groups. Health inequalities persisted, particularly for leprosy, with higher burdens in low-income regions than high-income regions (concentration index: -0.35). Economic factors such as health expenditure (Spearman's rank correlation coefficient, Conclusions: Although the burden of mycobacterial infection decreased, disparities remained-especially for tuberculosis. Increased public health investment and targeted strategies are essential for mitigating these inequities and their socioeconomic impact.