Tuberculosis remains one of the most consequential infectious disease failures of the modern era — not because science lacks solutions, but because implementation, funding, and drug resistance have conspired to keep it entrenched. With global health financing now under fresh pressure, this sweeping GBD 2023 analysis arrives as a critical baseline before disruptions reshape what is achievable.
Drawing on data from 204 countries and territories spanning 1990 to 2023, this systematic analysis quantifies TB mortality, morbidity, and disability-adjusted life-years (DALYs) using the Cause of Death Ensemble model alongside DisMod-MR 2.1 for simultaneous incidence-prevalence-mortality estimation. Crucially, the study stratifies results by both HIV status and drug-resistance profile — including multidrug-resistant TB (MDR-TB) — providing one of the most granular global burden portraits to date. A comparative risk assessment framework also attributes fractions of the burden to alcohol use, smoking, and elevated fasting plasma glucose, identifying modifiable upstream drivers often absent from TB control narratives.
The WHO End TB Strategy demands a 95% reduction in TB deaths and a 90% drop in incidence between 2015 and 2035 — targets this analysis is positioned to assess progress toward. The HIV-TB co-epidemic and MDR-TB trajectories represent the most intractable components; prior GBD cycles consistently showed these subpopulations lagging far behind overall TB trends. The inclusion of DALYs rather than mortality alone captures the substantial morbidity burden among survivors, which single-outcome analyses routinely undercount.
As a systematic analysis rather than a clinical trial, causal inference is limited, and country-level data quality varies enormously — verbal autopsy and minimally invasive tissue sampling fill gaps where vital registration is weak, introducing some uncertainty. Nonetheless, GBD studies of this scale function as the field's most authoritative epidemiological benchmarks. For health-conscious adults, the risk factor stratification is particularly actionable: it underscores that metabolic and behavioral risks intersect with infectious disease burden in ways that conventional TB prevention messaging rarely communicates.