The burden of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis and its attributable risk factors in 204 countries and territories, 1990–2021
- 1Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University)
Abstract
Objective: Anti-tuberculosis drug resistance has become a major challenge to global tuberculosis control. This study aims to comprehensively the global burden, trends, and risks for disease deaths of multidrug-resistant tuberculosis (MDR-TB), extensively drug-resistant tuberculosis (XDR-TB), HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB from 1990 to 2021.
Methods: Data on the incidence and deaths of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB were obtained from GBD 2021. The estimated annual percentage change (EAPC) and fold change were calculated to assess the trends of disease burden changes from baseline (1990 for MDR-TB and HIV/AIDS-MDR-TB; 1993 for XDR-TB and HIV/AIDS-XDR-TB) to 2021.
Results: In 2021, the highest age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR) were observed in MDR-TB globally, with 5.4161 (3.1676–9.3429) and 1.2791 (0.4992–2.5331) per 100,000 population, respectively. A significant increase in the global incidence and death burden of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB has been reported from baseline to 2021. Especially for HIV/AIDS-XDR-TB, death cases increased 84.89-fold, with an EAPC in ASDR of 10 (6.26–13.86). In contrast, MDR-TB demonstrated a comparatively smaller increase, with death cases rising 5.65-fold and an EAPC in ASDR of 1.18 (−0.37–2.75). Over the past 32 years, the incidence and death ratio of these types of DR-TB in the High-middle SDI region have been the highest. In terms of age patterns, the burden of MDR-TB and XDR-TB has increased most significantly in the 15–49 age group. In contrast, the burden of HIV/AIDS-MDR-TB and HIV/AIDS-XDR-TB has notably increased among those aged 5–14.
Conclusion: Over the past 30 years, a significant increase in the global burden of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB has been reported, with marked variations in various resistance types across different regions and countries. In particular, the high-middle SDI regions warrant special attention. These findings highlight the need for further research to identify effective intervention strategies tailored to the epidemiological patterns observed in different regions and populations.
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BibTeX
@article{wang2026burden,
title = {{The burden of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis and its attributable risk factors in 204 countries and territories, 1990–2021}},
author = {Hongping Wang and Shan Lv and Pu Yao and Jing Cen},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1960895},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1960895/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The burden of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis and its attributable risk factors in 204 countries and territories, 1990–2021
AU - Hongping Wang
AU - Shan Lv
AU - Pu Yao
AU - Jing Cen
PY - 2026
DA - 2026/10/26
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1960895
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1960895/full
AB - Objective: Anti-tuberculosis drug resistance has become a major challenge to global tuberculosis control. This study aims to comprehensively the global burden, trends, and risks for disease deaths of multidrug-resistant tuberculosis (MDR-TB), extensively drug-resistant tuberculosis (XDR-TB), HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB from 1990 to 2021. Methods: Data on the incidence and deaths of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB were obtained from GBD 2021. The estimated annual percentage change (EAPC) and fold change were calculated to assess the trends of disease burden changes from baseline (1990 for MDR-TB and HIV/AIDS-MDR-TB; 1993 for XDR-TB and HIV/AIDS-XDR-TB) to 2021. Results: In 2021, the highest age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR) were observed in MDR-TB globally, with 5.4161 (3.1676–9.3429) and 1.2791 (0.4992–2.5331) per 100,000 population, respectively. A significant increase in the global incidence and death burden of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB has been reported from baseline to 2021. Especially for HIV/AIDS-XDR-TB, death cases increased 84.89-fold, with an EAPC in ASDR of 10 (6.26–13.86). In contrast, MDR-TB demonstrated a comparatively smaller increase, with death cases rising 5.65-fold and an EAPC in ASDR of 1.18 (−0.37–2.75). Over the past 32 years, the incidence and death ratio of these types of DR-TB in the High-middle SDI region have been the highest. In terms of age patterns, the burden of MDR-TB and XDR-TB has increased most significantly in the 15–49 age group. In contrast, the burden of HIV/AIDS-MDR-TB and HIV/AIDS-XDR-TB has notably increased among those aged 5–14. Conclusion: Over the past 30 years, a significant increase in the global burden of MDR-TB, XDR-TB, HIV/AIDS-MDR-TB, and HIV/AIDS-XDR-TB has been reported, with marked variations in various resistance types across different regions and countries. In particular, the high-middle SDI regions warrant special attention. These findings highlight the need for further research to identify effective intervention strategies tailored to the epidemiological patterns observed in different regions and populations.
SN - 2296-2565
ER -