Global burden of HIV-negative multidrug- and extensively drug-resistant tuberculosis based on Global Burden of Disease Study 2021.

Background: Tuberculosis (TB), caused by , remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022. Of particular concern is the emergence of drug-resistant TB, accounting for 15%-20% of TB deaths. It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), drawing upon the comprehensive Global Burden of Disease (GBD) 2021 drug-resistant tuberculosis dataset.

Methods: From the GBD 2021, data on incidence, prevalence, disability-adjusted life years (DALYs), and death of MDR-TB and XDR-TB from 1990 to 2021 were collected. We calculated the estimated annual percentage changes in age standardized incidence rate (ASIR) and age-standardized death rate (ASDR), segmented by age, sex, and socio-demographic index (SDI). The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.

Results: In 2021, there were an estimated 443,680 (95% uncertainty interval []: 259,196-766,545) incident cases of MDR-TB, and an estimated 106,818 (95% : 41,612-211,854) death cases of MDR-TB, while there were an estimated 24,036 (95% : 17,144-34,587) incident cases of XDR-TB and 7,946 (95% : 3,326-14,859) death cases of XDR-TB. The incidence and death cases of MDR-TB were lowest in high SDI regions, whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.

Conclusion: This study reported the disease burden of drug-resistant TB from 1990 to 2021. Until 2021, drug-resistant TB is still a serious problem in low SDI countries, especially for high-risk age populations with high-risk factors. Controlling drug-resistant TB requires effective control strategies and healthcare systems.