ArticleFrontiers in public health2026
Changing epidemiological patterns of tuberculosis in China from 1990 to 2023: trends and future projections of drug-resistant and HIV-associated tuberculosis.
Article in Frontiers in public health, 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: China has made substantial progress in tuberculosis (TB) control over the past decades. However, continued surveillance of drug-resistant and HIV-associated TB remains essential for optimizing future TB control strategies. This study aimed to comprehensively assess the long-term burden and future trends of TB and its major subtypes in China, with particular emphasis on extensively drug-resistant TB (XDR-TB) and HIV-associated TB. Methods: Data on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of TB in China from 1990 to 2023 were extracted from the Global Burden of Disease Study 2023. Historical age-standardized rates were reported with 95% uncertainty intervals, and temporal trends in HIV-negative TB, drug-susceptible TB (DS-TB), multidrug-resistant TB (MDR-TB), XDR-TB, and HIV-associated TB subtypes were quantified using average annual percent changes (AAPCs) with 95% confidence intervals. Log-transformed age-standardized rates were projected from 2024 to 2035 using damped-trend exponential smoothing, ETS(A, Ad, N), with the damping parameter selected by rolling-origin validation. Forecasts were reported with 95% prediction intervals; projections to 2050 were treated as exploratory and reported in the Supplementary material. Results: From 1990 to 2023, the age-standardized incidence rates of HIV-negative TB, DS-TB, and MDR-TB declined overall in China, with AAPCs of -3.833, -3.877, and -2.859%, respectively. In contrast, XDR-TB increased markedly (AAPC 7.134%), while all HIV-associated TB subtypes also showed upward trends, particularly HIV-XDR-TB, which exhibited the fastest increase in incidence (AAPC 13.318%). Recent trends were more heterogeneous, including increases in HIV-negative TB and DS-TB incidence during 2019-2023 and declining or stable mortality trends for several drug-resistant and HIV-associated subtypes. By 2035, the incidence and prevalence of XDR-TB, HIV-DS-TB, and HIV-MDR-TB were projected to increase modestly, whereas their mortality and DALY rates were projected to decline. The XDR-TB incidence rate was projected to reach 0.172 per 100,000 population (95% prediction interval: 0.077-0.381). HIV-XDR-TB incidence was projected to remain broadly stable, with a slight decline, whereas its prevalence was projected to increase. Prediction intervals were wide for several low-burden drug-resistant outcomes. Conclusion: Although the overall TB burden in China has declined substantially, subtype-specific trajectories remain heterogeneous. Future control strategies should strengthen the rapid detection and management of drug resistance, integrate TB and HIV services, and prioritize targeted prevention and care for high-risk populations.
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