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Volume 15
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10.3390/pathogens15030295
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Article

Long-Term Trends and Determinants of Tuberculosis Burden in China, 1990–2023: Insights from the Global Burden of Disease Study 2023

by
Yingxing Wang
1,†,
Guozhong He
1,*,†,
Hoiman Ng
2,
Chaoxi Niu
3,
Rong Li
1,
Furong Zhang
1,
Ruimei Shi
1,
Xingyue Dian
1,
Qingping Ma
1 and
Zhong Sun
1,*
1
School of Public Health, Kunming Medical University, Kunming 650500, China
2
Clinical Laboratory, Kiang Wu Hospital, Macau 999078, China
3
Faculty of Data Science, City University of Macau, Macau 999078, China
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Pathogens 2026, 15(3), 295; https://doi.org/10.3390/pathogens15030295
Submission received: 13 January 2026 / Revised: 24 February 2026 / Accepted: 6 March 2026 / Published: 8 March 2026
(This article belongs to the Special Issue Emerging and Re-Emerging Human Infectious Diseases)
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Abstract

Tuberculosis (TB) remains a major public health challenge in China despite substantial long-term progress. Using data from the Global Burden of Disease Study 2023, this study reassessed trends and determinants of TB burden in China from 1990 to 2023. Age-standardized incidence, mortality, and disability-adjusted life year (DALY) rates were analyzed using estimated annual percentage change, age–period–cohort modeling, and demographic decomposition, with comparative risk assessment to quantify behavioral and metabolic contributions. Between 1990 and 2023, age-standardized incidence, mortality, and DALY rates declined by approximately 73.24%, 94.00%, and 92.40%, respectively. Negative net and local drift values indicated sustained reductions across age groups; however, the decline slowed after 2021, with a modest rebound in incidence. Since 2015, reductions in incidence have been more moderate than the pace required to achieve the 2035 End TB Strategy targets. Decomposition analysis demonstrated that improvements in age-specific rates were the primary drivers of long-term reductions, whereas demographic shifts—particularly population aging—partially offset these gains. The burden increasingly shifted toward older adults, and males consistently experienced higher rates than females. Tobacco and alcohol use contributed substantially to sex differentials, while undernutrition and metabolic disorders remained relevant risk factors. These findings indicate that China’s TB epidemic has entered a phase shaped by demographic aging and evolving risk structures, requiring sustained and adaptive control efforts.
Keywords: tuberculosis; China; Global Burden of Disease; age–period–cohort analysis; demographic transition; risk factors; latent tuberculosis infection; population aging tuberculosis; China; Global Burden of Disease; age–period–cohort analysis; demographic transition; risk factors; latent tuberculosis infection; population aging

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MDPI and ACS Style

Wang, Y.; He, G.; Ng, H.; Niu, C.; Li, R.; Zhang, F.; Shi, R.; Dian, X.; Ma, Q.; Sun, Z. Long-Term Trends and Determinants of Tuberculosis Burden in China, 1990–2023: Insights from the Global Burden of Disease Study 2023. Pathogens 2026, 15, 295. https://doi.org/10.3390/pathogens15030295

AMA Style

Wang Y, He G, Ng H, Niu C, Li R, Zhang F, Shi R, Dian X, Ma Q, Sun Z. Long-Term Trends and Determinants of Tuberculosis Burden in China, 1990–2023: Insights from the Global Burden of Disease Study 2023. Pathogens. 2026; 15(3):295. https://doi.org/10.3390/pathogens15030295

Chicago/Turabian Style

Wang, Yingxing, Guozhong He, Hoiman Ng, Chaoxi Niu, Rong Li, Furong Zhang, Ruimei Shi, Xingyue Dian, Qingping Ma, and Zhong Sun. 2026. "Long-Term Trends and Determinants of Tuberculosis Burden in China, 1990–2023: Insights from the Global Burden of Disease Study 2023" Pathogens 15, no. 3: 295. https://doi.org/10.3390/pathogens15030295

APA Style

Wang, Y., He, G., Ng, H., Niu, C., Li, R., Zhang, F., Shi, R., Dian, X., Ma, Q., & Sun, Z. (2026). Long-Term Trends and Determinants of Tuberculosis Burden in China, 1990–2023: Insights from the Global Burden of Disease Study 2023. Pathogens, 15(3), 295. https://doi.org/10.3390/pathogens15030295

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