The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
Background An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking
of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in
the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories.
Methods We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years
of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We
analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence
surveys, and estimated 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 observed tuberculosis
incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index
(SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also
estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors
including smoking, alcohol use, and diabetes.
Findings Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was
10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million
(9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals
who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of
prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million
to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (–4·1%
[–5·0 to –3·4]) than in incidence (–1·6% [–1·9 to –1·2]) and prevalence (–0·7% [–1·0 to –0·5]) among HIV-negative
individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for
incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative
tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3–13·0) of global tuberculosis
deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8–14·8), and smoking accounted
for 7·8% (3·8–12·0).
Interpretation Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease
burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality
of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are
priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development
should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use,
and diabetes could also substantially reduce the burden of tuberculosis.