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. 2025 Jun 25:13:1578658.
doi: 10.3389/fpubh.2025.1578658. eCollection 2025.

Global burden and trend of tuberculosis in children and adolescents (under 15 years old) from 1990 to 2021, with projections to 2040

Yuanhao Liang  1 , Jiayi Wang  2 , Jianzhou Yang  3 , Jinjia Liu  4 , Xiaofeng He  5
Affiliations

Global burden and trend of tuberculosis in children and adolescents (under 15 years old) from 1990 to 2021, with projections to 2040

Yuanhao Liang et al. Front Public Health. .

Abstract

Background: Tuberculosis (TB) remains a significant global health issue, but its burden among children and adolescents under 15 years old is not well quantified. This study evaluates TB trends in this age group from 1990 to 2021 and projects future trends through 2040.

Methods: We used data from the Global Burden of Disease Study (GBD) 2021 to assess the incidence and mortality of TB in children and adolescents (under 15) from 1990 to 2021. A Bayesian age-period-cohort model was employed to project the TB burden.

Results: In 2021, there were 799,047 new TB cases and 81,870 TB-related deaths among children, with an age-standardized incidence rate (ASIR) of 40.01 per 100,000 population and an age-standardized mortality rate (ASMR) of 4.16 per 100,000 population. From 1990 to 2021, the ASIR declined by 2.4% annually, while ASMR decreased by 4.19% per year. However, drug-resistant TB, especially extensively drug-resistant TB, increased significantly. The burden was highest in low-SDI regions, particularly among children under 5, who accounted for over 75% of TB-related deaths. Projections to 2040 indicate continued declines in ASIR and ASMR for all TB forms, including drug-resistant and TB-HIV co-infections.

Conclusion: Sustained investment in TB control programs, particularly in low-SDI regions, is crucial. Addressing drug-resistant TB and TB-HIV co-infection should be prioritized in global public health strategies.

Keywords: age-standardized rate; children and adolescents; estimated annual percentage change; global burden of disease; tuberculosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Age-standardized incidence and mortality rates of tuberculosis, and proportions of incident cases and deaths contributed by each type of tuberculosis, globally and for 21 GBD regions, 2021. Age-standardized incidence rates (A) and mortality rates (B) of each type of tuberculosis. Proportions of incident cases (C) and deaths (D) accounted for by each type of tuberculosis. DS-TB = Drug-susceptible tuberculosis. MDR-TB = Multidrug-resistant tuberculosis without extensive drug resistance. XDR-TB = Extensively drug-resistant tuberculosis. HIV-DS-TB = HIV-infected drug-susceptible tuberculosis. HIV-MDR-TB = HIV-infected multidrug-resistant tuberculosis without extensive drug resistance. HIV-XDR-TB = HIV-infected extensively drug-resistant tuberculosis.
Figure 2
Figure 2
Age-standardized incidence rate (ASIR) for tuberculosis among children and adolescents under 15 years old across 204 countries and territories in 2021. (A) DS-TB; (B) MDR-TB; (C) XDR-TB; (D) HIV-DS-TB; (E) HIV-MDR-TB; (F) HIV-XDR-TB. DS-TB = Drug-susceptible tuberculosis. MDR-TB = Multidrug-resistant tuberculosis without extensive drug resistance. XDR-TB = Extensively drug-resistant tuberculosis. HIV-DS-TB = HIV-infected drug-susceptible tuberculosis. HIV-MDR-TB = HIV-infected multidrug-resistant tuberculosis without extensive drug resistance. HIV-XDR-TB = HIV-infected extensively drug-resistant tuberculosis.
Figure 3
Figure 3
Estimated annual percentage changes in age-standardized incidence rate (ASIR) for tuberculosis among children and adolescents under 15 years old across 204 countries and territories from 1990 to 2021. (A) DS-TB; (B) MDR-TB; (C) XDR-TB; (D) HIV-DS-TB; (E) HIV-MDR-TB; (F) HIV-XDR-TB. DS-TB = Drug-susceptible tuberculosis. MDR-TB = Multidrug-resistant tuberculosis without extensive drug resistance. XDR-TB = Extensively drug-resistant tuberculosis. HIV-DS-TB = HIV-infected drug-susceptible tuberculosis. HIV-MDR-TB = HIV-infected multidrug-resistant tuberculosis without extensive drug resistance. HIV-XDR-TB = HIV-infected extensively drug-resistant tuberculosis.
Figure 4
Figure 4
Global temporal trends in the age-standardized incidence rate (ASIR) (A) and age-standardized mortality rate (ASMR) (B) for specific forms of tuberculosis among children and adolescents under 15 years old from 1990 to 2021, with projections through 2040. The blue shaded area represents the 95% uncertainty interval (UI), highlighting the upper and lower bounds.
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