Abstract:

Objective: With analyzing the burden and attributable risk factors of tuberculosis (TB) in China from 2000 to 2021, and projecting the disease burden from 2022 to 2035, to provide evidence for the formulation of public health policies. Methods: With data from the Global Burden of Disease Study 2021 (GBD 2021), the TB burden in China was assessed using age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rate (ASDR). We analyzed the impact of gender and age on TB burden, adopted the Joinpoint regression model for the changing trend and conducted the Mann-Kendall trend tests. The Autoregressive Integrated Moving Average (ARIMA) model was applied to project the TB burden from 2022 to 2035, with model performance evaluated using the mean absolute percentage error (MAPE), mean absolute error (MAE), and root mean square error (RMSE). Trends in risk factors attributable to smoking, alcohol use, and high fasting plasma glucose were also analyzed. Results: From 2000 to 2021, China observed a downward trend in ASIR, ASMR, and ASDR for TB. By 2021, the ASIR (36.28 per 100000), ASMR (1.91 per 100000), and ASDR (76.22 per 100000) decreased by 54.16%, 81.46%, and 79.67% respectively compared with the ASIR (79.15 per 100000), ASMR (10.30 per 100000), and ASDR (374.96 per 100000) in 2000. The proportion of TB patients aged 60 and above in China in 2021 (41.77%) increased by 42.80% compared with that in 2000 (29.25%).The male-to-female ratio across age groups showed an increasing annual trend, with the >85 age group contributing the most to the sex disparity in 2021 (19.3%). Projections for 2022—2035 indicated a continuous decline, with ASIR, ASMR, and ASDR estimated to reach 17.38, 0.65, and 14.35 per 100000 by 2035, respectively. Regarding risk factors, the proportion attributable to smoking initially rose and then stabilized, with the proportion attributable to smoking 21% in 2000, 26% in 2014, and 25% in 2021.While the proportion attributable to alcohol use showed a steady and continuous increase, with 12% in 2000 and 18% in 2021.The proportion attributable to high fasting plasma glucose initially increased and then declined, with 8% in 2000, 10% in 2015, and 9% in 2021. Smoking in males accounted for the highest attributable proportion (34%) in 2021. Conclusion: Although the burden of TB in China declined significantly from 2000 to 2021, it remains relatively high among males and the elderly. Given the high contribution of smoking in males and the steady rise in alcohol-attributable burden, public health strategies should prioritize strengthening tobacco control and promoting healthy lifestyles. Targeted prevention and control measures focusing on the elderly and male populations are essential.

Key words: Tuberculosis, Disease burden, Models, statistical, Epidemiologic studies