Global inequality in the burden of tuberculosis: findings from the Global Burden of Disease Study 2021.

BACKGROUND: Tuberculosis (TB) is one of the leading causes of death worldwide. The United Nations' Sustainable Development Goals include a target to reduce TB burden inequalities among countries. However, the current extent of TB burden inequality among countries remains unclear. This study aims to analyze the global burden inequality of TB. METHODS: This study utilized the Global Burden of Disease (GBD) 2021 database to extract TB-related data from 204 countries and territories, including age-standardized rates (ASRs) of disability-adjusted life years (DALYs) and population from 1990 to 2021 and annual DALY rates across different age groups. By conducting statistical analyses, we calculated the slope index of inequality (SII) and the Gini index for each country and territory to assess the inequalities in the burden of TB. RESULTS: The global SII reached an estimated 3,107.34×10-5 in 2021, a decrease of 56.32% from 1990. In contrast, the Gini index exhibited an upward trend, rising from 0.57 in 1990 to 0.60 in 2021. At the regional level, the burden of TB showed significant disparities. The SII and Gini index generally showed a pattern of first declining and then increasing with age. CONCLUSIONS: While absolute inequalities in TB burden have declined, relative inequalities persist as a significant concern, especially in specific regions and age groups. Future research should investigate the underlying drivers of these inequalities to better guide TB control strategies.