Tuberculosis Incidence Trends from 1990 to 2017 Highlight Impact of Drug Resistance: Results from the Global Burden of Disease Study
Abstract Objectives This study aimed to determine the global incidence trends of tuberculosis (TB) from 1990 to 2017.Methods Data was obtained from the Global Burden of Disease (GBD) study. The estimated annual percentage changes (EAPCs) were calculated with the age-standardised incidence rate (ASIR) to estimate trends in incidence of TB, including multidrug-resistant TB (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB).Results Globally, the number of TB cases was 8965.81×103 in 2017, with a 9.42% increase since 1990. The ASIR for TB showed a decreasing trend from 1990 to 2017 (EAPC = −1.19, 95% confidence interval [CI]: −1.32 to −1.07). Meanwhile, decreasing trends were observed in 162 countries/territories, particularly in Ethiopia and China where EAPCs were −4.51 (95%CI: −5.22 to −3.80) and −4.21 (95%CI: −4.98 to −3.44), respectively. However, obvious increasing trends of MDR-TB cases occurred in areas with low and low-middle sociodemographic indexes (SDI), with EAPCs of 7.97 (95%CI: 2.47 to 13.75) and 6.30 (95%:1.17 to 11.68), respectively. The ASIR for XDR-TB showed pronounced increasing trends globally from 1991 to 2017, with an EAPC of 11.74 (95%CI: 7.50 to 16.16). The largest rising trends of XDR-TB were observed in Kyrgyzstan (EAPC = 31.06, 95%CI: 23.07 to 39.57), followed by Azerbaijan and Uzbekistan.Conclusions There was a decreasing trend for TB incidence worldwide, although it was more pronounced in specific countries and regions. However, the rapidly rising trends of MDR-TB and XDR-TB cases in low and low-middle SDI areas and countries may have an adverse impact on the global control of TB.