Global Burden of Tuberculosis in Adults Aged 65 Years and Older, 1990–2021: A Population-Based Study

Background To estimate the burden, trends, and inequalities of tuberculosis (TB) among older adults at the global, regional, and national levels from 1990 to 2021. Methods We analyzed the global burden of tuberculosis in adults aged ≥ 65 years using data from the GBD Study 2021 across 204 countries from 1990 to 2021. Disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) were assessed, with uncertainty quantified by 95% CIs . Countries were grouped by region and sociodemographic index (SDI). Descriptive statistics, age-standardized rates (ASRs), and average annual percentage changes (AAPCs) were computed to evaluate TB burden variations by age, sex, and location. Changes in factors affecting DALYs for tuberculosis in older adults were also analyzed. Results Between 1990 and 2021, the proportion of tuberculosis-related DALYs among older adults increased from 12.45% to 18.38% of the total population. In 2021, an estimated 8.63 million individuals aged 65 years and older (95% UI 7.75 to 9.74) were affected by TB-related DALYs, with an age-standardized rate of 1,122 per 100,000 population. Although the age-standardized DALY rate for older adults steadily declined from 1990 to 2021, the annual reduction was slower than that of the overall population (-3.26% per year [95% UI -3.38% to -3.15%]). While YLLs decreased, the proportion of YLDs rose from 6.5% to 10.2% of total DALYs during the same period. Men consistently showed higher DALY counts and rates than women across all age groups in 2021. Globally, TB-related DALYs decreased across sociodemographic strata, with the largest declines in high SDI countries (-4.98% [95% UI -5.19% to -4.78%]) and the slowest in low SDI countries (-2.73% [95% UI -2.85% to -2.62%]). In 2021, Central and Eastern Sub-Saharan Africa (9,899 and 8,439 per 100,000, respectively) had the highest DALY rates, whereas high-income regions had the lowest. High fasting plasma glucose, tobacco use, and alcohol consumption were key contributors to TB DALYs, with only fasting plasma glucose rising between 1990 and 2021. Conclusions The tuberculosis burden among older adults has significantly increased, with disparities observed across countries with varying sociodemographic indices, accounting for nearly one-fifth of the global TB burden by 2021. Managing high fasting plasma glucose levels remains a major challenge for older adults. Targeted guidelines are urgently needed to address these specific health needs.