1990—2023年全球0~14岁儿童结核病负担评估与2024—2050年趋势预测

doi:10.19982/j.issn.1000-6621.20250432

摘要/Abstract

摘要：

目的: 分析1990—2023年全球0~14岁儿童结核病负担趋势,探讨社会人口学指数(sociodemographic index, SDI)与年龄相关性,预测至2050年的负担变化,为2035年世界卫生组织(World Health Organization, WHO)“终结结核病流行”战略提供依据。方法: 基于1990—2023年全球疾病负担(global burden of disease, GBD)研究数据,采用估计年度变化百分比(estimated annual percentage change, EAPC)分析儿童结核病发病率、死亡率及伤残调整寿命年(disability-adjusted life years, DALYs)的时间趋势;运用自回归积分移动平均(autoregressive integrated moving average, ARIMA)模型,预测至2050年的疾病负担。结果: 1990—2023年,全球0~14岁儿童结核病发病数、死亡数、DALYs分别下降45.06%、67.05%、65.13%,年龄标准化发病率(age-standardized incidence rate, ASIR)从133.01/10万降至63.18/10万,年龄标准化死亡率(age-standardized mortality rate, ASMR)从11.61/10万降至3.50/10万,年龄标准化DALYs率(age-standardized DALYs rate, ASDR)从1074.08/10万降至341.96/10万,EAPC范围为-3.92%~-2.38%(P值均<0.001)。2023年,低SDI地区占儿童结核病死亡数的76.85%(51328.34/66789.10),其ASMR(7.71/10万)是高SDI地区(0.09/10万)的85.67倍;<5岁年龄组儿童死亡数最高,为48452.88例,其ASMR(7.54/10万)远高于5~9岁儿童(1.33/10万)。ARIMA模型预测,2050年全球儿童结核病ASIR为36.83/10万,ASMR为1.39/10万,ASDR为142.34/10万。结论: 1990—2023年全球儿童结核病负担显著下降,但低SDI地区和<5岁儿童仍是高负担群体;需推广儿童友好型诊断工具,扩大预防性治疗及耐多药结核病精准干预,以实现2035年“终结结核病流行”的目标。

关键词: 儿童, 结核, 疾病负担, 预测

Abstract:

Objective: To analyze the trend of global tuberculosis burden of children aged 0-14 years from 1990 to 2023, explore the correlation between social demographic index (SDI) and age, predict the burden change to 2050, and provide the basis for the World Health Organization (WHO) strategy of “ending tuberculosis epidemic” in 2035. Methods: Based on the global burden of disease (GBD) research data from 1990 to 2023, the estimated annual percentage change (EAPC) was used to analyze the time trend of incidence rate, mortality and disability adjusted life years (DALYs) of children’s tuberculosis; Using the autoregressive integrated moving average (ARIMA) model, predict the disease burden until 2050. Results: From 1990 to 2023, the incidence, death and DALYs of tuberculosis in children aged 0 to 14 years in the world decreased by 45.06%, 67.05% and 65.13% respectively, the age standardized incidence rate (ASIR) decreased from 133.01/100000 to 63.18/100000, the age standardized mortality rate (ASMR) decreased from 11.61/100000 to 3.50/100000, the age standardized DALYs rate (ASDR) decreased from 1074.08/100000 to 341.96/100000, EAPC The range is -3.92%--2.38% (P<0.001). In 2023, low SDI areas will account for 76.85% (51328.34/66789.10) of child tuberculosis deaths, and their ASMR (7.71/100000) will be 85.67 times that of high SDI areas (0.09/100000); Children under the age of 5 have the highest number of deaths, with 48452.88 cases, and their ASMR (7.54/100000) is much higher than that of children aged 5-9 (1.33/100000). ARIMA model predicts that the global ASIR of children’s tuberculosis in 2050 will be 36.83/100000, ASMR will be 1.39/100000, and ASDR will be 142.34/100000. Conclusion: Despite substantial global declines in the childhood TB burden from 1990 to 2023, significant inequalities remain, concentrated in low-SDI regions and among children under 5 years. Achieving the 2035 “End TB” target necessitates targeted scaling up of child-friendly diagnostics, expanded preventive therapy, and precise interventions for MDR-TB.

Key words: Child, Tuberculosis, Burden of disease, Forecasting

中图分类号:

R521

刘麟, 殷小成, 张小佛, 梁麟龙, 杨炬. 1990—2023年全球0~14岁儿童结核病负担评估与2024—2050年趋势预测[J]. 中国防痨杂志, 2026, 48(6): 840-848. doi: 10.19982/j.issn.1000-6621.20250432

Liu Lin, Yin Xiaocheng, Zhang Xiaofo, Liang Linlong, Yang Ju. Global burden of tuberculosis in children aged 0-14 years, 1990—2023, and trend projections for 2024—2050[J]. Chinese Journal of Antituberculosis, 2026, 48(6): 840-848. doi: 10.19982/j.issn.1000-6621.20250432

图/表 6

表1

图1

图2

图3

图4

图5

参考文献 37

[1]	屈燕, 李涛, 马文斌, 等. 世界卫生组织《2025年全球结核病报告》解读. 结核与肺部疾病杂志, 2025, 6 (6): 613-623. doi:10.19983/j.issn.2096-8493.20250178.
[2]	胡鑫洋, 高静韬. 世界卫生组织《2024年全球结核病报告》解读. 结核与肺部疾病杂志, 2024, 5 (6): 500-504. doi:10.19983/j.issn.2096-8493.2024164.
[3]	成诗明, 周林, 赵顺英, 等. 中国儿童结核病防治手册. 2版. 北京: 人民卫生出版社, 2017.
[4]	Verkuijl S, Bastard M, Brands A, et al. Global reporting on TB in children and adolescents: how far have we come and what remains to be done?. IJTLD Open, 2024, 1(1): 3-6. doi:10.5588/ijtldopen.23.0529.
[5]	World Health Organization. Who Launches New 5-Year Roadmap to Prevent and Treat Tb in Children and Adolescents. Geneva: World Health Organization, 2023.
[6]	卢水华. 儿童结核病诊治的新认识. 诊断学理论与实践, 2015, 14(5): 397-401. doi:10.16150/j.1671-2870.2015.05.002.
[7]	刘芳, 焦伟伟, 申阿东. 儿童结核病诊断与治疗面临的问题与思考. 中华实用儿科临床杂志, 2022, 37(7): 486-489. doi:10.3760/cma.j.cn101070-20220124-00089.
[8]	中华医学会结核病学分会儿童结核病专业委员会, 中国研究型医院学会结核病学专业委员会, 国家呼吸系统疾病临床医学研究中心, 等. 儿童肺结核诊断专家共识. 中华实用儿科临床杂志, 2022, 37(7): 490-496. doi:10.3760/cma.j.cn101070-20211207-01436.
[9]	王以琳, 孙琪, 钱卓, 等. 儿童结核病诊断延迟病例的临床特点及危险因素分析. 中国感染与化疗杂志, 2024, 24(5): 507-514. doi:10.16718/j.1009-7708.2024.05.002.
[10]	World Health Organization. WHO Global Tuberculosis Programme. Treatment of drug-resistant tuberculosis in children: operational handbook. Geneva: World Health Organization, 2024.
[11]	陈伟, 李雪, 刘小秋, 等. 《全国结核病防治规划(2024—2030年)》解读. 中国防痨杂志, 2025, 47(2): 130-136. doi:10.19982/j.issn.1000-6621.20240585.
[12]	GBD 2019 Tuberculosis Collaborators. Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990—2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis, 2022, 22(2): 222-241. doi:10.1016/S1473-3099(21)00449-7.
[13]	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990—2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132. doi:10.1016/S0140-6736(24)00367-2.
[14]	Li X, Li Y, Guo L, et al. Tuberculosis incidence, deaths and disability-adjusted life years in children and adolescence, 1990—2021: Results from the Global Burden of Disease Study 2021. PLoS One, 2025, 20(3): e0317880. doi:10.1371/journal.pone.0317880.
[15]	Liang Y, Wang J, Yang J, et al. Global burden and trend of tuberculosis in children and adolescents (under 15 years old) from 1990 to 2021, with projections to 2040. Front Public Health, 2025, 13: 1578658. doi:10.3389/fpubh.2025.1578658.
[16]	Fu L, Liu K, Sun Y, et al. Global, Regional, and National Burden of Tuberculosis Among Children: A Population-Based Study. Trop Med Infect Dis, 2026, 11(2): 43. doi:10.3390/tropicalmed11020043.
[17]	GBD 2021 Demographics Collaborators Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950—2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440):1989-2056. doi:10.1016/S0140-6736(24)00476-8.
[18]	Tan CS, Støer N, Ning Y, et al. Quantifying temporal trends of age-standardized rates with odds. Popul Health Metr, 2018, 16(1):18. doi:10.1186/s12963-018-0173-5.
[19]	Hyndman RJ, Khandakar Y. Automatic time series forecasting: The forecast package for R. J Stat Softw, 2008, 27(3): 1-22. doi:10.18637/jss.v027.i03.
[20]	World Health Organization. WHO consolidated guidelines on tuberculosis: Module 5: Management of tuberculosis in children and adolescents. Geneva: World Health Organization, 2022.
[21]	World Health Organization. Operational handbook on tuberculosis. Module 1: prevention-tuberculosis preventive treatment. 2nd ed. Geneva: World Health Organization, 2020.
[22]	Carvalho ACC, Cardoso CAA, Martire TM, et al. Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy. J Bras Pneumol, 2018, 44(2): 134-144. doi:10.1590/s1806-37562017000000461.
[23]	Buonsenso D, Autore G, Cusenza F, et al. Multidrug-resis-tant tuberculosis in children: Are the same therapy options available worldwide?. Int J Infect Dis, 2023, 130 Suppl 1: S16-S19. doi:10.1016/j.ijid.2023.03.023.
[24]	Derese D, Teklu T, Kumalo A, et al. Test agreement between GeneXpert and urine lipoarabinomannan test for tuberculosis diagnosis among children in Ethiopia. BMC Pediatr, 2025, 25 (1): 254. doi:10.1186/s12887-024-05344-3.
[25]	Brow LR, Smith M, van Schalkwyk C, et al. Epidemiology of Pediatric Tuberculosis in the Western Cape: A Population-Based Study (2017—2023). Pediatrics, 2026, 157(2): e2025072223. doi:10.1542/peds.2025-072223.
[26]	Dodd PJ, Yuen CM, Sismanidis C, et al. The global burden of tuberculosis mortality in children: a mathematical modelling study. Lancet Glob Health, 2017, 5(9): e898-e906. doi:10.1016/S2214-109X(17)30289-9.
[27]	du Preez K, Gabardo BMA, Kabra SK, et al. Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries. Pathogens, 2022, 11(2): 196. doi:10.3390/pathogens11020196.
[28]	Lan QW, Chen HK, Huang ZM, et al. Global, regional, and national time trends in incidence for tuberculosis, 1990—2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study. Heart Lung, 2024, 65: 19-30. doi:10.1016/j.hrtlng.2024.01.009.
[29]	d’Elbée M, Mafirakureva N, Chabala C, et al. Treatment decision algorithms for tuberculosis screening and diagnosis in children below 5 years hospitalised with severe acute malnutrition: a cost-effectiveness analysis. EClinicalMedicine, 2025, 83: 103206. doi:10.1016/j.eclinm.2025.103206.
[30]	Basile FW, Nabeta P, Ruhwald M, et al. Pediatric Tuberculosis Diagnostics: Present and Future. J Pediatric Infect Dis Soc, 2022, 11(Supplement_3): S85-S93. doi:10.1093/jpids/piac082.
[31]	World Health Organization.Global tuberculosis report 2023. Geneva: World Health Organization, 2023.
[32]	Jaganath D, Wambi P, Reza TF, et al. A Prospective Evaluation of Xpert MTB/RIF Ultra for Childhood Pulmonary Tuberculosis in Uganda. J Pediatric Infect Dis Soc, 2021, 10(5): 586-592. doi:10.1093/jpids/piaa159.
[33]	Signorino C, Votto M, De Filippo M, et al. Diagnostic accuracy of Xpert ultra for childhood tuberculosis: A preliminary systematic review and meta-analysis. Pediatr Allergy Immunol, 2022, 33 Suppl 27(Suppl 27): 80-82. doi:10.1111/pai.13637.
[34]	中国防痨协会. 高危人群结核分枝杆菌潜伏感染检测及预防性治疗专家共识. 中国防痨杂志, 2021, 43(9): 874-878. doi:10.3969/j.issn.1000-6621.2021.09.004.
[35]	Jang JG, Chung JH. Diagnosis and treatment of multidrug-resistant tuberculosis. Yeungnam Univ J Med, 2020, 37(4): 277-285. doi:10.12701/yujm.2020.00626.
[36]	Hesseling AC, Purchase SE, Martinson NA, et al. Levofloxacin Preventive Treatment in Children Exposed to MDR Tuberculosis. N Engl J Med, 2024, 391(24): 2315-2326. doi:10.1056/NEJMoa2314318.
[37]	Portnoy A, Clark RA, Quaife M, et al. The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: A modeling study. PLoS Med, 2023, 20(1): e1004155. doi:10.1371/journal.pmed.1004155.

分组	发病			死亡			DALYs
	ASIR(/10万)		EAPC (%)	ASMR(/10万)		EAPC (%)	ASDR(/10万)		EAPC (%)
	1990年	2023年	EAPC (%)	1990年	2023年	EAPC (%)	1990年	2023年	EAPC (%)
全球	133.01	63.18	―2.38	11.61	3.50	―3.92	1074.08	341.96	―3.75
性别
女性	163.48	74.37	―2.51	12.30	3.58	―4.17	1151.79	356.15	―3.98
男性	104.13	52.64	―2.21	10.95	3.43	―3.65	1000.48	328.59	―3.52
年龄组(岁)
<5	145.14	76.43	―2.18	24.16	7.54	―3.86	2211.04	714.26	―3.76
5~9	119.57	50.03	―2.69	5.20	1.33	―4.25	516.28	151.63	―3.85
10~14	133.90	62.49	―2.38	4.47	1.33	―3.86	403.63	130.64	―3.63
SDI水平
低	280.06	116.89	―2.74	26.89	7.71	―4.00	2468.32	739.47	―3.87
中低	186.06	57.76	―3.91	16.53	2.64	―5.79	1527.11	267.42	―5.53
中	121.21	55.10	―2.33	9.77	1.52	―5.60	911.07	159.79	―5.26
中高	89.64	37.10	―2.75	5.78	0.92	―5.78	545.93	100.05	―5.35
高	34.97	7.54	―4.81	1.94	0.09	―9.53	183.96	11.89	―8.68