Global, regional, and national burden of tuberculosis and multidrug-resistant tuberculosis by HIV status, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04–10·3) incident cases of all-form TB, 1·22 million (0·98–1·49) deaths, and 54·6 million (43·8–65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000–879 000) incident cases and 210 000 (142 000–279 000) deaths, contributing 11·0 million (7·56–14·3) DALYs. MDR-TB accounted for 466 000 (198 000–1 080 000) incident cases, 102 000 (31 700–238 000) deaths, and 3·96 million (1·31–9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8–20·5) and deaths declined by 22·6% (4·7–35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000–970 000) and DALYs to 34·9 million (27·8–43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400–183 000) and DALYs to 3·12 million (1·03–7·29).
Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress.