Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study
Open accessAbstract
BACKGROUND: Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. METHODS: We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. FINDINGS: Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05-10·16) and the number of tuberculosis deaths was 1·21 million (1·16-1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01-1·89) and the number of tuberculosis deaths was 0·24 million (0·16-0·31). Globally, among HIV-negative individuals the age-standardised incidence of tuberculosis decreased annually at a slower rate (-1·3% [-1·5 to -1·2]) than mortality did (-4·5% [-5·0 to -4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was -4·0% (-4·5 to -3·7) and mortality was -8·9% (-9·5 to -8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). INTERPRETATION: If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV. FUNDING: Bill & Melinda Gates Foundation.
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Global annual rates of decline in tuberculosis incidence over the past 10 years have ranged between 1% and 2%.
“Recent progress has been unimpressive, however, as global annual rates of decline in tuberculosis incidence over the past 10 years have ranged between 1% and 2%.3, 4”
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- Authors
- Kyu, H. H., Maddison, E. R., Henry, N. J., Ledesma, J. R., Wiens, K. E., Reiner, R., Biehl, M. H., Shields, C., Osgood-Zimmerman, A., Ross, J. M., Carter, A., Frank, T. D., Wang, H., Srinivasan, V., Agarwal, S. K., Alahdab, F., Alene, K. A., Ali, B. A., Alvis-Guzman, N., Andrews, J. R., Antonio, C. A. T., Atique, S., Atre, S. R., Awasthi, A., Ayele, H. T., Badali, H., Badawi, A., Barac, A., Bedi, N., Behzadifar, M., Behzadifar, M., Bekele, B. B., Belay, S. A., Bensenor, I. M., Butt, Z. A., Carvalho, F., Cercy, K., Christopher, D. J., Daba, A. K., Dandona, L., Dandona, R., Daryani, A., Demeke, F. M., Deribe, K., Dharmaratne, S. D., Doku, D. T., Dubey, M., Edessa, D., El-Khatib, Z., Enany, S., Fernandes, E., Fischer, F., Garcia-Basteiro, A. L., Gebre, A. K., Gebregergs, G. B., Gebremichael, T. G., Gelano, T. F., Geremew, D., Gona, P. N., Goodridge, A., Gupta, R., Haghparast Bidgoli, H., Hailu, G. B., Hassen, H. Y., Hedayati, M. T. T., Henok, A., Hostiuc, S., Hussen, M. A., Ilesanmi, O. S., Irvani, S. S. N., Jacobsen, K. H., Johnson, S. C., Jonas, J. B., Kahsay, A., Kant, S., Kasaeian, A., Kassa, T. D., Khader, Y. S., Khafaie, M. A., Khalil, I., Khan, E. A., Khang, Y.-H., Kim, Y. J., Kochhar, S., Koyanagi, A., Krohn, K. J., Kumar, G. A., Lakew, A. M., Leshargie, C. T., Lodha, R., Macarayan, E. R. K., Majdzadeh, R., Martins-Melo, F. R., Melese, A., Memish, Z. A., Mendoza, W., Mengistu, D. T., Mengistu, G., Mestrovic, T., Moazen, B., Mohammad, K. A., Mohammed, S., Mokdad, A. H., Moosazadeh, M., Mousavi, S. M., Mustafa, G., Nachega, J. B., Nguyen, L. H., Nguyen, S. H., Nguyen, T. H., Ningrum, D. N. A., Nirayo, Y. L., Nong, V. M., Ofori-Asenso, R., Ogbo, F. A., Oh, I.-H., Oladimeji, O., Olagunju, A. T., Oren, E., Pereira, D. M., Prakash, S., Qorbani, M., Rafay, A., Rai, R. K., Ram, U., Rubino, S., Safiri, S., Salomon, J. A., Samy, A. M., Sartorius, B., Satpathy, M., Seyedmousavi, S., Sharif, M., Silva, J. P., Silveira, D. G. A., Singh, J. A., Sreeramareddy, C. T., Tran, B. X., Tsadik, A. G., Ukwaja, K. N., Ullah, I., Uthman, O. A., Vlassov, V., Vollset, S. E., Vu, G., Weldegebreal, F., Werdecker, A., Yimer, E. M., Yonemoto, N., Yotebieng, M., Naghavi, M., Vos, T., Hay, S. I., & Murray, C. J. L.
- Affiliations
- University of Washington (US)
- ORCID
- Kyu, Hmwe Hmwe
- Maddison, Emilie R
- Henry, Nathaniel J
- Ledesma, Jorge R
- Wiens, Kirsten E
- Reiner, Robert
- Shields, Chloe
- Osgood-Zimmerman, Aaron
- Ross, Jennifer M
- Carter, Austin
- Frank, Tahvi D
- Wang, Haidong
- Srinivasan, Vinay
- Agarwal, Sanjay Kumar
- Alahdab, Fares
- Alene, Kefyalew Addis
- Andrews, Jason R
- Antonio, Carl Abelardo T
- Atique, Suleman
- Atre, Sachin R
- Awasthi, Ashish
- Badali, Hamid
- Badawi, Alaa
- Barac, Aleksandra
- Bedi, Neeraj
- Behzadifar, Masoud
- Behzadifar, Meysam
- Bekele, Bayu Begashaw
- Belay, Saba Abraham
- Butt, Zahid A
- Carvalho, Félix
- Christopher, Devasahayam J
- Daba, Alemneh Kabeta
- Dandona, Lalit
- Dandona, Rakhi
- Daryani, Ahmad
- Demeke, Feleke Mekonnen
- Deribe, Kebede
- Dharmaratne, Samath Dhamminda
- Doku, David Teye
- Dubey, Manisha
- Edessa, Dumessa
- Enany, Shymaa
- Fernandes, Eduarda
- Fischer, Florian
- Gebre, Abadi Kahsu
- Gebregergs, Gebremedhin Berhe
- Gebremichael, Teklu Gebrehiwo
- Gelano, Tilayie Feto
- Geremew, Demeke
- Gona, Philimon N
- Goodridge, Amador
- Gupta, Rahul
- Hassen, Hamid Yimam
- Hedayati, Mohammad T. Tadesse
- Henok, Andualem
- Hostiuc, Sorin
- Hussen, Mamusha Aman
- Ilesanmi, Olayinka Stephen
- Irvani, Seyed Sina Naghibi
- Jacobsen, Kathryn H
- Johnson, Sarah C
- Kahsay, Amaha
- Kant, Surya
- Kasaeian, Amir
- Kassa, Tesfaye Dessale
- Khader, Yousef Saleh
- Khafaie, Morteza Abdullatif
- Khan, Ejaz Ahmad
- Khang, Young-Ho
- Kim, Yun Jin
- Kochhar, Sonali
- Koyanagi, Ai
- Kumar, G Anil
- Lakew, Ayenew Molla
- Leshargie, Cheru Tesema
- Macarayan, Erlyn Rachelle King
- Majdzadeh, Reza
- Melese, Addisu
- Memish, Ziad A
- Mengistu, Desalegn Tadese
- Moazen, Babak
- Mohammad, Karzan Abdulmuhsin
- Mohammed, Shafiu
- Mokdad, Ali H
- Moosazadeh, Mahmood
- Mousavi, Seyyed Meysam
- Nachega, Jean B
- Nguyen, Long Hoang
- Nguyen, Son Hoang
- Nguyen, Trang Huyen
- Ningrum, Dina Nur Anggraini
- Nong, Vuong Minh
- Ogbo, Felix Akpojene
- Oh, In-Hwan
- Oladimeji, Olanrewaju
- Olagunju, Andrew T
- Oren, Eyal
- Pereira, David M.
- Prakash, Swayam
- Qorbani, Mostafa
- Ram, Usha
- Rubino, Salvatore
- Safiri, Saeid
- Salomon, Joshua A
- Samy, Abdallah M.
- Sartorius, Benn
- Satpathy, Maheswar
- Seyedmousavi, Seyedmojtaba
- Sharif, Mehdi
- Silva, João Pedro
- Silveira, Dayane Gabriele Alves
- Singh, Jasvinder A
- Sreeramareddy, Chandrashekhar T
- Tran, Bach Xuan
- Tsadik, Afewerki Gebremeskel
- Ukwaja, Kingsley Nnanna
- Ullah, Irfan
- Uthman, Olalekan A
- Vlassov, Vasily
- Vu, Giang
- Weldegebreal, Fitsum
- Werdecker, Andrea
- Yimer, Ebrahim M
- Yonemoto, Naohiro
- Yotebieng, Marcel
- Naghavi, Mohsen
- Vos, Theo
- Hay, Simon I
- Murray, Christopher J L
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 18
- Issue
- 12
- Pages
- 1329-1349
- ISSN
- 1473-3099 (ISSN-L)
- PMC
- PMC6250050
- OpenAlex
- W2901714497
- Cited by
- 437
- References
- 44
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 34 · 2023: 47 · 2022: 30 · 2021: 34 · 2020: 241 · 2019: 21 · 2018: 1
- FWCI
- 56.16
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Infectious Diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Tampere University Institutional Repository (Tampere University) (publishedVersion, cc-by)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DSPACE System - Metalibrary (University of the Coast) (acceptedVersion, cc-by-nc-sa)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- UnissResearch (Università degli Studi di Sassari) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion, cc-by)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- George Mason University
- United Nations Population Fund
- Ohio State University
- San Diego State University
- Harvard University
- Johns Hopkins University
- University of Pittsburgh
- McGill University
- Jazan University
- West Virginia University
- Wellcome Trust (201-900/Z/16/Z, 201900)
- Public Health Agency of Canada
- University of Massachusetts Boston
- Iran University of Medical Sciences
- Ahmadu Bello University
- Trường Đại học Nguyễn Tất Thành
- Trường Đại học Duy Tân
- Maragheh University of Medical Sciences
- Universitas Negeri Semarang
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- University of Warwick
- University College London
- Public Health Foundation of India
- Public Health Agency
- Monash University
- Ain Shams University
- Seoul National University
- Kyung Hee University
- Islamic Azad University
- Bundesministerium für Gesundheit
- University of Toronto
- Jordan University of Science and Technology
- Karolinska Institutet
- Mazandaran University of Medical Sciences
- Tampereen Yliopisto
- Tehran University of Medical Sciences and Health Services
- Taipei Medical University
- Haramaya University
- Ahvaz Jundishapur University of Medical Sciences
- Jimma University
- Universidade de São Paulo
- Università degli Studi di Sassari
- Universität Bielefeld
- Shahid Beheshti University of Medical Sciences
- Universidade do Porto
- National Research University Higher School of Economics
- University of the Philippines
- Universitatea de Medicină şi Farmacie "Carol Davila" Bucureşti
- University of Gondar
- Addis Ababa University
- University of Hail
- Xiamen University
- University of Peradeniya
- International Medical University
- Mekelle University
- National Center of Neurology and Psychiatry
- Hawassa University
- Alborz University of Medical Sciences
- Lorestan University of Medical Sciences
- University of Namibia
- Frankfurt University of Applied Sciences
- Applied Molecular Biosciences Unit
- Western Sydney University
- Rede de Química e Tecnologia
- Laboratório Associado para a Química Verde
- Alfaisal University
- Universitair Ziekenhuis Antwerpen
- Debre Markos University
- Dilla University
- Debre Tabor University
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences
- Erasmus Universitair Medisch Centrum Rotterdam
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Social Sciences › General Social Sciences › HIV, TB, and STIs Epidemiology
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- tuberculosis burden, tuberculosis incidence, tuberculosis mortality, HIV coinfection, drug-resistant tuberculosis, tuberculosis prevalence, age-standardized incidence rate, mortality trends, socio-demographic index, tuberculosis control policy, verbal autopsy, civil registration, tuberculosis notification
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Communicable Disease Control, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Risk Factors, Tuberculosis, Global Health, Incidence, Prevalence, Survival Analysis, Young Adult, Epidemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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