Global, Regional, and National Burden of Tuberculosis Among Children: A Population-Based Study

Abstract

Background: Tuberculosis remains a major global public health challenge, particularly among children. This study aims to provide a comprehensive assessment of the global, regional, and national burden of tuberculosis among children (0-14 years) using data from the Global Burden of Disease (GBD) 2021 study. Methods: Data on the incidence of tuberculosis (drug-susceptible, MDR-TB, and XDR-TB), as well as disability-adjusted life years (DALYs), among children aged 0-14 years in 204 countries and territories from 1990 to 2021 were obtained from the GBD 2021 study. Estimated annual percentage changes (EAPCs) in age-standardised incidence rates (ASIRs) and DALY rate were calculated overall and stratified by age, sex, and sociodemographic index (SDI) to quantify temporal trends. Spearman correlation analyses were performed to assess associations between tuberculosis burden and SDI. Results: In 2021, there were an estimated 759,300 new tuberculosis cases (ASIR: 37.7 per 100,000 population) among children globally, including 32,515 cases of MDR-TB (ASIR: 1.6) and 1193 cases of XDR-TB (ASIR: 0.1). Both global ASIR and DALY rate exhibited a declining trend from 1990 to 2021, with EAPC of -2.61% (95%CI: -2.74 to -2.47) and -4.38% (-4.61 to -4.14), respectively. From 1990 to 2021, High-income North America was the only GBD region with an increasing ASIR for tuberculosis (EAPC = 1.12, 95% CI: 0.61 to 1.64). From 1990 to 2021, there was no significant change in ASIR of MDR-TB (EAPC = 1.18, 95% CI: -0.16 to 2.54). However, eight of the 21 GBD regions exhibited increasing trends in the ASIR of MDR-TB, with the largest increase observed in Oceania (11.99, 10.49 to 13.52), followed by Central Asia (9.76, 6.48 to 13.13) and South Asia (5.71, 3.10 to 8.38). A strong negative correlation was observed between tuberculosis burden and SDI, with the highest disease burden concentrated in low-SDI regions. Conclusions: Achieving elimination targets will require stronger diagnostics and treatment for childhood tuberculosis, alongside reduced transmission, improved infection detection, and preventive therapy for exposed children, especially those under 5 years.

Keywords: DALY; children; global burden of diseases (GBD); incidence; tuberculosis.

Figure 1

(A) Age-standardised incidence rates (ASIR) of tuberculosis among children per 100,000 population in 2021; (B) estimated annual percentage change in ASIR from 1990 to 2021; (C) age-standardised DALY rate of tuberculosis among children per 100,000 population in 2021; (D) estimated annual percentage change in age-standardised DALY rate from 1990 to 2021. DALY: disability-adjusted life years.

Figure 2

Age-standardised incidence rates (A) and age-standardised DALY rate (B) of tuberculosis among children in different age groups from 1990 to 2021. Age-standardised incidence rates (C) and age-standardised DALY rate (D) of different types of tuberculosis among children from 1990 to 2021.

Figure 3

(A) Age-standardised incidence rates of tuberculosis among children for the 21 GBD regions by sociodemographic index, 1990–2021; (B) Age-standardised DALY rate of tuberculosis among children for the 21 GBD regions by sociodemographic index, 1990–2021. The solid line indicates the spline-based expected age-standardised rate as a function of SDI (model-predicted mean), estimated from all region–year observations. Regions above the solid line represent a higher-than-expected burden, and regions below the line show a lower-than-expected burden. DALYs: disability-adjusted life years; GBD: Global Burden of Diseases.

Figure 4

Age-standardised incidence and DALY rate of tuberculosis and proportions of incident cases and DALYs contributed by tuberculosis among children, globally and for 21 GBD regions, 2021. (A) Proportions of incident cases globally and for 21 GBD regions; (B) Proportions of DALYs globally and for 21 GBD regions; (C) Age-standardised incidence rate globally and for 21 GBD regions; (D) Age-standardised DALY rate globally and for 21 GBD regions.