Burden of multidrug-resistant and extensively drug-resistant tuberculosis in China, India and Russia: estimates from the GBD 2023 study.

BACKGROUND: Multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB/XDR-TB) strains are complicating global tuberculosis (TB) control, with China, India, and Russia bearing the heaviest burdens. This study aimed to map their epidemiological profiles to guide targeted interventions. METHODS: Epidemiological data were collected from the Global Burden of Disease Study (GBD) 2023. Joinpoint regression, decomposition, age-period-cohort, and autoregressive integrated moving average (ARIMA) analyses were performed. RESULTS: China, India, and Russia ranked among the top three globally in the absolute number of MDR-TB/XDR-TB cases. Over the past 30 years, China had seen a significant decrease in the age-standardized rate of MDR-TB, contrasting with the rising trends in India and Russia, with epidemiological changes being the main driving factor. China had a significantly negative net drift value for XDR-TB mortality, indicating an overall decline across age groups over time, whereas India and Russia had significantly positive values, indicating an overall increase across age groups. In recent years, the burden of XDR-TB had decreased in China and Russia, while there had been no significant change in India. In all three countries, disease burden was higher in men than women, with significant differences in peak age. Predictions indicate rising XDR-TB prevalence in India and Russia, while China's indicators were expected to stabilize. CONCLUSIONS: MDR-TB/XDR-TB's epidemiological characteristics differ significantly among China, India, and Russia, necessitating the development of differentiated prevention and control strategies and strengthened joint efforts.