Global burden of tuberculosis among adults aged 60 years and older,1990-2021: findings from the global burden of disease study 2021

Junping Liu; Yue Zhou; Juan Guan; Yaping Liu; Weijian Song; Wei Liu; Xinle Yin; Yuqin Liu; Ting Li; Long Jin; Lihan Zhang; Yunkai Li; Lin Wu; Nan Wang; Zhaoyue Liu; Xinru Liu; Yanfu Wang; Qunhong Wu; Libo Liang

doi:10.1016/j.ijid.2025.107966

Global burden of tuberculosis among adults aged 60 years and older,1990-2021: findings from the global burden of disease study 2021

Int J Infect Dis. 2025 Jun 26:107966. doi: 10.1016/j.ijid.2025.107966. Online ahead of print.

Authors

Junping Liu¹, Yue Zhou¹, Juan Guan¹, Yaping Liu¹, Weijian Song¹, Wei Liu¹, Xinle Yin¹, Yuqin Liu², Ting Li², Long Jin², Lihan Zhang¹, Yunkai Li¹, Lin Wu¹, Nan Wang¹, Zhaoyue Liu¹, Xinru Liu¹, Yanfu Wang³, Qunhong Wu¹, Libo Liang⁴

Affiliations

¹ Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150081, China.
² Infectious Disease Hospital of Heilongjiang Province, Harbin, 150500, China.
³ Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, 150030, China.
⁴ Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150081, China.. Electronic address: llbhit@163.com.

PMID: 40581250
DOI: 10.1016/j.ijid.2025.107966

Abstract

Objectives: Tuberculosis (TB) poses a significant threat to global public health, particularly among the elderly. This study aim to provide a comprehensive analysis of the pattern and temporal trends of the global disease burden associated with HIV-negative TB in adults aged 60 years and older from 1990 to 2021.

Methods: Data on incidence, deaths, and disability-adjusted-life-years (DALYs) of TB, drug-susceptible tuberculosis (DS-TB), multidrug-resistant tuberculosis (MDR-TB), and extensively drug-resistant tuberculosis (XDR-TB) were obtained from the Global Burden of Disease (GBD) 2021. Frontier analysis was carried out to pinpoint areas for enhancement and disparities among nations stratified by development level. Bayesian age-period-cohort model (BAPC) was utilized to forecast disease burden trends through 2035.

Results: A decline trend in age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and DALY rates for TB and DS-TB was observed among the elderly population globally, whereas an upward trend was noted of MDR-TB and XDR-TB. Frontier analyses revealed a potential for burden alleviation among diverse nations and regions, with high SDI nations like the Republic of Korea showing higher disease burden than expected for their sociodemographic development. BAPC model revealed that by 2035, the MDR-TB and XDR-TB burden will continue escalating in the elderly.

Conclusions: The increasing MDR-TB and XDR-TB burden in older individuals underscores the need for tailored interventions to combat TB burden, such as implementing active case finding (ACF) among adults aged 60 years and older.

Keywords: Disease burden; Frontier analysis; GBD 2021; Tuberculosis; the elderly.