Global Epidemiological Trends of Tuberculosis 1990-2021 and Projection to 2040

Introduction: Tuberculosis (TB) remains a major global health challenge, with over 10 million new cases and 1.5 million deaths annually. Despite significant declines in TB burden since 1990, disparities persist across regions and genders. Behavioral, metabolic, and socioeconomic factors exacerbate TB morbidity and mortality. This study analyzes global, regional, and national trends in TB incidence, mortality, and disability-adjusted life years 1990–202 using the Global Burden of Disease (GBD) database and projects future trends to 2040. Methods: Data from the GBD 2021 database were analyzed to evaluate TB incidence, deaths, and DALYs, per 100,000 population. Age, sex, and region-specific trends were examined, with stratification by Socio-Demographic Index (SDI) levels. Projections to 2040 were performed using ARIMA and ETS models. Statistical significance was assessed using t-tests and paired Wilcoxon tests. Results: In 2021, globally, the total number of cases and deaths of TB were estimated to be 4684699 and 725384 in Males and 3,722,433 and 437411 in females. From 1990-2021, global incidence, deaths, and DALYs rates declined consistently, with males experienced higher TB burden. Smoking and alcohol use for males and high fasting plasma glucose for females were the major contributors of death in TB. Low SDI regions, particularly Sub-Saharan Africa, recorded the higher TB burden, while high SDI regions achieved significant reductions. Projections to 2040 indicate further declines in TB incidence and mortality, narrowing gender disparities. Discussion: Global declines in TB metrics reflect advancements in public health policies, diagnostic tools, and treatment strategies. However, disparities persist, driven by socioeconomic determinants and risk factors. Strengthened interventions targeting poverty, comorbidities, and behavioral and metabolic risks are essential for high-burden regions. This study emphasizes the importance of integrated, region-specific strategies to accelerate global TB control and achieve sustainable reductions by 2040