National and subnational burden of XDR-TB in China,1990-2023: Long-term trends, regional disparities, and projections, 2024-2050

SummaryObjectives China still faces a heavy Tuberculosis (TB) burden; extensively drug-resistant tuberculosis (XDR-TB) prevalence rises sharply amid overall TB decline, with no national/provincial comprehensive assessment of its trends and drivers hampering targeted control and resource allocation. This study analyzes 1990–2023 XDR-TB indicators to support precision TB control. Methods The data of study was from Global Burden of Disease Study (GBD) 2023 and Chinese Center for Disease Control and Prevention. The analyzed indicators include age-standardized rates (ASR) and absolute case numbers for incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLL), and years lived with disability (YLD). Joinpoint regression models were used to analyze the changing trends of XDR-TB burden indicators from 1990 to 2023 and calculate the annual percentage change. Results In 2023, the age-standardized incidence rate (ASIR) of XDR-TB in China was 0.143 per 100,000 population (95% UI: 0.017, 0.436), with 2,436 cases (95% UI: 296, 7,697). The age-standardized mortality rate (ASMR) was 0.018 per 100,000 population(95% UI: 0.002, 0.066), with 388 deaths (95% UI: 44, 1,408). From 1990 to 2023, XDR-TB in China exhibited an increasing trend in ASIR (AAPC = 7.134, 95% CI: 5.766, 8.503), age-standardized prevalence rate (ASPR, AAPC=7.800, 95% CI: 7.022, 8.578), ASMR (AAPC = 1.762, 95% CI: 0.778, 2.747). Xinjiang ranking first in ASIR, ASPR, and ASYLDR. Tibet ranked first in ASMR, ASDR, and ASYLLR. Xinjiang led in deaths, DALYs, and YLL cases. From 1990 to 2023, all 33 administrative regions in China showed an increasing trend in XDR-TB indicators, with Hong Kong, Macao, and western regions such as Tibet and Xinjiang experiencing the largest increases in these ASR, with Hong Kong's ASIR, Macao's ASPR, and Tibet's ASDR showing the fastest growth. Conclusion The geographic disparities and age distribution patterns of XDR-TB in China provide a foundation for precision control strategies. Particular attention is needed for the western regions, especially Xinjiang and Tibet. Future efforts should focus on targeted interventions in high-risk areas and strengthening prevention measures for the elderly to further reduce the XDR-TB burden.