Tuberculosis remains one of the most consequential infectious disease challenges of the modern era, and understanding exactly where progress has stalled — and why — is essential as funding cuts threaten decades of hard-won gains. This landmark analysis arrives at a critical inflection point, offering the most comprehensive quantitative picture yet of TB's global footprint and the adequacy of the response trajectory leading toward WHO's ambitious 2035 targets.
Drawing on the Global Burden of Disease Study 2023 framework, this systematic analysis quantified TB mortality, morbidity, and disability-adjusted life-years (DALYs) across 204 countries and territories from 1990 through 2023. The methodology layered vital registration records, verbal autopsy data, surveillance systems, and minimally invasive tissue sampling to estimate cause-specific mortality, while DisMod-MR 2.1 simultaneously modeled incidence, prevalence, and mortality stratified by age and sex. Critically, the team applied population attributable fraction approaches to disaggregate burden by HIV co-infection status and drug-resistance profile — including multidrug-resistant TB — and assessed the contributions of modifiable risk factors including alcohol use, smoking, and elevated fasting plasma glucose to overall TB burden.
This analysis carries unusual weight for several reasons. GBD studies are methodologically among the most rigorous in global health epidemiology, with wide national coverage and decades of longitudinal comparability. The stratification by HIV status is particularly important: HIV-associated TB carries dramatically higher case fatality and requires integrated treatment strategies that differ substantially from HIV-negative TB management. The MDR-TB layer adds further urgency — drug-resistant strains complicate treatment regimens, balloon costs, and worsen outcomes. The explicit benchmarking against WHO End TB targets of 95% mortality reduction and 90% incidence reduction by 2035 (relative to 2015) provides a clear accountability framework. The inclusion of modifiable behavioral and metabolic risk factors — alcohol, smoking, hyperglycemia — signals that TB control cannot be decoupled from broader noncommunicable disease prevention. For health-conscious adults globally, this signals that metabolic health has infectious disease consequences extending well beyond cardiovascular risk.