Trends in burden of multidrug-resistant tuberculosis in countries, regions, and worldwide from 1990 to 2017: results from the Global Burden of Disease study

Abstract

Background: Antituberculosis-drug resistance is an important public health issue, and its epidemiological patterns has dramatically changed in recent decades. This study aimed to estimate the trends of multidrug-resistant tuberculosis (MDR-TB), which can be used to inform health strategies.

Methods: Data were collected from the Global Burden of Disease study 2017. The estimated annual percentage changes (EAPCs) were calculated to assess the trends of MDR-TB burden at global, regional, and national level from 1990 to 2017 using the linear regression model.

Results: Globally, the age-standardized rate (ASR) of MDR-TB burden including incidence, prevalence, death and disability-adjusted life years (DALYs) had pronounced increasing trends from 1990 to 1999, with the EAPCs were 17.63 [95% confidence interval (CI): 10.77-24.92], 17.57 (95% CI 11.51-23.95), 21.21 (95% CI 15.96-26.69), and 21.90 (95% CI 16.55-27.50), respectively. Particularly, the largest increasing trends were seen in areas and countries with low and low-middle sociodemographic index (SDI). However, the trends in incidence, prevalence, death and DALYs of MDR-TB decreased globally from 2000 to 2017, with the respective EAPCs were - 1.37 (95% CI - 1.62 to - 1.12), - 1.32 (95% CI - 1.38 to - 1.26), - 3.30 (95% CI - 3.56 to - 3.04) and - 3.32 (95% CI - 3.59 to - 3.06). Decreasing trends of MDR-TB were observed in most regions and countries, particularly that of death and DALYs in Slovenia were - 18.96 (95% CI - 20.82 to - 17.06) and -19.35 (95% CI - 21.10 to - 17.55), respectively. Whereas the pronounced increasing trends of MDR-TB occurred in Papua New Guinea, Singapore, and Australia.

Conclusions: The ASR of MDR-TB showed pronounced decreasing trends from 2000 to 2017. However, the MDR-TB burden remains a substantial challenge to the TB control globally, and requires effective control strategies and healthcare systems.

Keywords: Age-standardized rate; Epidemiological trend; Estimated annual percentage change; Global burden of disease; Multidrug-resistant tuberculosis.

Fig. 1

The trends of MDR-TB burden including incidence, prevalence, death, and DALYs globally, and in SDI areas and geographic regions. a The EAPCs of MDR-TB burden from 1990 to 1999; b The EAPCs of MDR-TB burden from 2000 to 2017. MDR-TB: multidrug resistant tuberculosis; DALYs: disability-adjusted life-years; EAPC: estimated annual percentage change; SDI: socio-demographic index.

Fig. 2

The distribution of the incident number of MDR-TB globally, and in SDI areas and geographic regions from1990 to 2017. a The incident number of MDR-TB in age groups; b The changing of incident number of MDR-TB in SDI areas; c The incident number of MDR-TB in geographical regions. MDR-TB: multidrug resistant tuberculosis; SDI: socio-demographic index

Fig. 3

The distribution of ASR, percentage changes in absolute number, and EAPC of MDR-TB incidence at a national level during 2000–2017. a The ASR of MDR-TB incidence in 2017 in countries/territories; b The percentage changes in absolute incident number of MDR-TB between 2000 and 2017 in countries/territories; c The EAPCs of MDR-TB incidence in countries/territories from 2000 to 2017. Countries/territories with an extreme value were annotated. MDR-TB: multidrug resistant tuberculosis; ASR: Age-standardized rate; EAPC: Estimated annual percentage change

Fig. 4

The correlation between EAPCs (2000–2017) and ASR in 2000 at a national level. The EAPCs of MDR-TB burden including incidence (a), prevalence (b), death (c), and DALYs (d) had a positive correlation with the ASR in 2000, respectively. The correlation was calculated with Pearson correlation analysis. The size of circle increases with the numbers in 2000 in the corresponding countries. MDR-TB: multidrug resistant tuberculosis; ASR: Age-standardized rate; EAPC: Estimated annual percentage change; HDI: Human development index; DALYs: disability-adjusted life-years.

Fig. 5

The correlation between EAPCs (2000–2017) and HDI in 2017 at a national level. a The EAPCs of death due to MDR-TB had a negative correlation with the HDI in 2017; b The EAPCs of DALYs due to MDR-TB had a negative correlation with the HDI in 2017. The correlation was calculated with Pearson correlation analysis. The circles represent countries that were available on HDI data, and the size of circle increases with the numbers in 2017 in the corresponding countries. MDR-TB: multidrug resistant tuberculosis; ASR: Age-standardized rate; EAPC: Estimated annual percentage change; HDI: Human development index