Global, Regional, and National Burden of Tuberculosis Among Older Adults from 1990 to 2021: A Systematic Analysis Based on the 2021 Global Burden of Disease

Background Tuberculosis persists as a leading global cause of mortality, with older adults facing elevated vulnerability due to immunosenescence and comorbidities. Leveraging Global Burden of Disease 2021 data, this study presents the first comprehensive analysis of spatiotemporal trends in TB burden among adults aged 60 + years from 1990 to 2021, directly supporting WHO's targeted intervention priorities. Method Age-standardized rates were computed using the GBD global standard population. Temporal inflection points were identified through joinpoint regression and annual percentage change analysis. Age-period-cohort effects underwent orthogonal decomposition, while population growth, aging, and epidemiological contributions to burden shifts were quantified. Future burden projections through 2050 employed Bayesian modeling with integrated nested Laplace approximation. Socioeconomic disparities were evaluated using slope and concentration indices correlated with sociodemographic status. Modifiable mortality risk factors including hyperglycemia and smoking were assessed via GBD risk attribution frameworks. Results During 1990–2021, age-standardized TB incidence, prevalence, mortality, and DALY rates declined by 69.60%, 53.47%, 83.79%, and 84.03% respectively in the 60 + population. Nevertheless, this demographic sustains 2.079 million annual incident cases and 551,000 deaths, with males and low-SDI regions—particularly central sub-Saharan Africa—experiencing disproportionate burdens. Relative socioeconomic disparities intensified despite narrowing absolute gaps. Modifiable risks demonstrated extreme mortality rate gradients, with low-SDI regions exhibiting up to 77-fold higher attributable mortality than high-SDI areas. Projections indicate a decline to 18.95 mortality per 100,000 by 2050, though predictive uncertainty escalates over time. Population growth remains the primary driver of rising cases in developing regions, while epidemiological improvements partially counterbalance aging effects. Conclusion Post-2015 health advancements have accelerated global TB burden reduction, yet persistent polarization reflects health system fragility and metabolic risk interactions in low-SDI settings. Gender disparities correlate strongly with male-predominant risk behaviors. Escalating relative inequality underscores resource allocation imbalances. Future control strategies must integrate chronic disease management frameworks while addressing drug resistance and climate-mediated threats.