Tuberculosis in South Asia: A regional analysis of burden, progress, and future projections using the global burden of disease (1990-2021)

Vijay Kumar; Mahalaqua Nazli Khatib; Amit Verma; Sorabh Lakhanpal; Suhas Ballal; Sanjay Kumar; Mahakshit Bhat; Aryantika Sharma; M Ravi Kumar; Aashna Sinha; Abhay M Gaidhane; Muhammed Shabil; Mahendra Pratap Singh; Sanjit Sah; Kiran Bhopte; Kamal Kundra; Shailesh Kumar Samal

doi:10.1016/j.jctube.2024.100480

Tuberculosis in South Asia: A regional analysis of burden, progress, and future projections using the global burden of disease (1990-2021)

J Clin Tuberc Other Mycobact Dis. 2024 Oct 9:37:100480. doi: 10.1016/j.jctube.2024.100480. eCollection 2024 Dec.

Authors

Vijay Kumar¹, Mahalaqua Nazli Khatib², Amit Verma³, Sorabh Lakhanpal⁴, Suhas Ballal⁵, Sanjay Kumar⁶, Mahakshit Bhat⁷, Aryantika Sharma⁸, M Ravi Kumar⁹, Aashna Sinha¹⁰, Abhay M Gaidhane¹¹, Muhammed Shabil^{12

13}, Mahendra Pratap Singh^{1

14}, Sanjit Sah^{15

16

17}, Kiran Bhopte¹⁸, Kamal Kundra¹⁹, Shailesh Kumar Samal²⁰

Affiliations

¹ Evidence for Policy and Learning, Global Center for Evidence Synthesis, Chandigarh, India.
² Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
³ Department of Medicine, Graphic Era Institute of Medical Sciences, Graphic Era (Deemed to be University), Clement Town, Dehradun, India.
⁴ School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India.
⁵ Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India.
⁶ Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan 303012, India.
⁷ Department of Medicine, National Institute of Medical Sciences, NIMS University Rajasthan, Jaipur, India.
⁸ Chandigarh Pharmacy College, Chandigarh Group of Colleges-Jhanjeri, Mohali 140307, Punjab, India.
⁹ Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh 531162, India.
¹⁰ Uttaranchal Institute of Pharmaceutical Sciences, Division of Research and Innovation, Uttaranchal University, India.
¹¹ Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India.
¹² University Center for Research and Development, Chandigarh University, Mohali 140413 Punjab, India.
¹³ Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq.
¹⁴ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
¹⁵ SR Sanjeevani Hospital, Kalyanpur, Siraha 56517, Nepal.
¹⁶ Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune 411018, Maharashtra, India.
¹⁷ Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 411018, Maharashtra, India.
¹⁸ IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh 462044, India.
¹⁹ New Delhi Institute of Management, Delhi, India.
²⁰ Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.

Abstract

Background: Tuberculosis (TB) is a major public health issue in South Asia and accounts for a large share of the global TB burden. Despite global efforts to curb TB incidence and mortality, progress in South Asia has been uneven, necessitating focused regional analysis to guide effective interventions. This study aims to analyse the trends in the TB burden in South Asia from 1990 to 2021 and project future TB incidence rates up to 2031.

Methods: This study utilized data from the Global Burden of Disease (GBD) 2021 results to analyse trends in age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) rates (ASDR) associated with TB in South Asia from 1990 to 2021. Joinpoint regression analysis was employed to identify significant trends, whereas ARIMA models were used to project future TB incidence rates up to 2031.

Results: This study revealed significant declines in the ASIR, ASPR, ASDR, and ASMR related to TB in South Asia over the past three decades. Prominent reductions were found in Bangladesh and Bhutan, whereas India, Pakistan, and Nepal continue to bear the highest TB burdens. The ARIMA model projections indicate a continued decline in TB incidence across the region, although the extent of the decline varies by country, with less favourable trends observed in Nepal and Pakistan. The analysis also highlights tobacco use, high fasting plasma glucose, and high body mass index as significant risk factors contributing to the TB burden.

Conclusions: Substantial progress has been made in reducing the TB burden in South Asia; however, sustained and intensified efforts are needed, particularly in countries with inconsistent progress. These findings emphasize the need for targeted interventions to meet the WHO End TB Strategy (WETS) targets by 2035. Continuous monitoring and adaptive strategies will be crucial in maintaining and accelerating progress toward TB elimination in South Asia.

Keywords: ARIMA; Global burden of disease; Joinpoint regression; South Asia; Tuberculosis.