Trends in Tuberculosis Mortality among the Elderly in China, 2004-2021: A Jointpoint Regression and Age-Period-Cohort Analysis

Background Tuberculosis (TB) has long placed a heavy burden on society and healthcare systems in China and worldwide. With the aging of population, TB in the elderly is becoming a significant public health concern. This study examined secular trends in TB mortality among the elderly in China and the net effects of age, period, and cohort. Methods The data were obtained from the National Disease Surveillance Points (DSPs) system. The joinpoint regression model was used to calculate the annual percentage change in TB mortality among people aged 60 years and over in China from 2004 to 2021. The age-period-cohort (APC) analysis based on the intrinsic estimator (IE) method was utilized to estimate the independent effects of age, period and cohort. Results The age-standardized mortality rate of TB was 5.68 per 100,000, with higher rates for males than for females, in rural areas than in urban areas, and in western than in central and eastern regions. TB mortality among the elderly in China showed a continuous downward trend in different demographic groups from 2004 to 2021, with a slower rate of decline in recent years. The APC analysis model showed that TB mortality among the elderly in China increased with age, with the RR increasing from 0.57 in the 60–64 age group to 1.53 in the 80–84 age group. The period effect on TB mortality among the elderly in China continuously decreased from 2007 to 2021. Stratified results showed that the risk effect was higher in rural areas (RR = 1.51, 95% CI: 1.47–1.54) than in urban areas (RR = 1.16, 95% CI: 1.08–1.25) for the period 2007–2011 and higher in urban areas (RR = 0.81, 95% CI: 0.75–0.88) than in rural areas (RR = 0.73, 95% CI: 0.71–0.75) for the period 2017–2021. The cohort effect on TB mortality presented a continuously decreasing trend, with the exception of certain demographic groups that tended to increase in the 1952–1956 and 1957–1961 birth cohorts. Conclusions TB mortality among the elderly continued to decline in China from 2004 to 2021, although the rate of decline had slowed in recent years. There were differences in age, period and cohort effects on TB mortality among gender, urban and rural areas and regions. This study revealed the temporal trend of TB mortality among the elderly in China and provided clues for etiologic studies, which in turn can help develop effective intervention strategies.