Diabetes-Attributable Tuberculosis Burden: Global Disparities by Socio-Demographic Index, National Trends in Asia, and Projections (2017–2030)

Background The syndemic interaction between diabetes and tuberculosis (TB) represents a growing threat to global health equity, yet comprehensive assessments of its spatiotemporal burden across heterogeneous Asian populations remain limited. Methods Utilizing the Global Burden of Disease (GBD) 2017–2021 datasets, we conducted a multinational longitudinal analysis across nine Asian economies stratified by socio-demographic index (SDI), age, gender, and TB subtype. Age-standardized mortality, disability-adjusted life years (DALYs), and years lived with disability (YLDs) attributable to high fasting plasma glucose (FPG) were quantified. Compound annual growth rates (CAGR) with 95% uncertainty intervals (UI) were derived via bounded endpoint sensitivity analysis. Age-cohort trajectories were modeled using longitudinal linkage algorithms, while gender-disaggregated burdens were computed through arithmetic averaging. Temporal projections employed SARIMA models for stable-trend countries (China/Japan) and joinpoint regression with Monte Carlo permutation for variable-trend nations (India/Pakistan/Bangladesh). Results Low-SDI regions exhibited 81-fold higher TB-FPG mortality (8.10/100,000) than high-SDI regions (0.10/100,000), with South Asia bearing the highest burden—Pakistan recorded peak mortality (11.04/100,000 males) and DALYs (259.16/100,000). Drug-susceptible TB drove > 95% of attributable burden, while latent TB contributed negligibly. Pronounced age escalation was observed, with India’s elderly (> 70 years) experiencing extreme mortality (50.59/100,000) and DALYs (849.75/100,000). Gender disparities revealed 1.8–4.6-fold higher burdens in males. Despite universal declines, South Asia lagged in YLD reduction (e.g., India: − 0.3%/year). Projections (2026–2030) indicate accelerated mortality reductions in Bangladesh (AAPC=–4.2%, p < 0.05) but persistent DALY disparities in Pakistan (172.15/100,000 by 2026). Conclusion This study identifies critical syndemic hotspots in South Asia’s aging male populations and drug-susceptible TB cohorts. The decoupled decline in fatal versus non-fatal burdens underscores unmet needs in disability management. Our validated projection models provide evidence for targeting precision interventions to accelerate TB elimination in diabetes-endemic settings.