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

## TL;DR

This study analyzes how tuberculosis rates in China have changed from 1990 to 2023 and identifies factors influencing these trends.

## Contribution

The study provides updated insights into China's TB burden using the latest Global Burden of Disease data and identifies demographic and behavioral determinants.

## Key findings

- Age-standardized TB incidence, mortality, and DALY rates declined significantly from 1990 to 2023.
- Population aging and slower progress since 2021 are key factors affecting TB trends.
- Tobacco and alcohol use contribute to sex differences in TB burden.

## 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.