Global, regional, and national burdens of tuberculosis attributable to smoking from 1990 to 2021

doi:10.19982/j.issn.1000-6621.20250519

Abstract

Abstract:

Objective: To comprehensively assess the smoking-related tuberculosis burden from 1990 to 2021 and explore potential improvement room. Methods: Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed mortality and disability-adjusted life years (DALYs) attributable to smoking-related tuberculosis, stratified by age, sex, and socio-economic development level. Decomposition analysis was applied to identify key drivers of burden changes, while frontier analysis was used to visualize the potential for burden reduction at various levels of development. Results: From 1990 to 2021, the global age-standardized mortality rate of tuberculosis attributable to smoking decreased from 14.17 per 100000 population to 3.84 per 100000 population, and the age-standardized DALYs decreased from 483.39 per 100000 population to 136.43 per 100000 population, with estimated annual percentage changes (EAPC) of -4.33% and -4.21%, respectively. The smoking-related tuberculosis burden declined across all examined age groups aged 30-89 years, with the largest decrease in the mortality rate observed in the 65-69 year age group (EAPC: -4.57%) and the largest decrease in the DALY rate observed in the 60-64 year age group (EAPC: -4.48%). Among 204 countries and territories, the smoking-related tuberculosis burden generally showed a downward trend; only Lesotho and Zimbabwe showed increasing trends in age-standardized disability-adjusted life years rate (ASDR), whereas the remaining 202 countries and territories showed decreasing trends. In 2021, the age-standardized mortality rate (ASMR) and ASDR in low-socio-demographic index (SDI) regions were 9.80 per 100000 population and 320.81 per 100000 population, respectively, higher than those in high-SDI regions, which were 0.21 per 100000 population and 7.08 per 100000 population, suggesting an overall negative association between SDI and the smoking-related tuberculosis burden. Decomposition analysis showed that the declines in global deaths and DALYs were mainly driven by epidemiological changes, with contribution rates of 250.49% and 239.43%, respectively. Frontier analysis indicated that the smoking-related tuberculosis burden varied substantially across countries at the same SDI level; Lesotho, Kiribati, and Zimbabwe had relatively large ASDR effective differences of 3428.92, 2018.03, and 1425.11, respectively. Conclusion: The global burden of tuberculosis attributable to smoking showed a clear downward trend from 1990 to 2021, yet notable regional disparities persist, especially in low-SDI regions where the burden remains disproportionately high. Strengthening proactive and targeted tobacco control strategies is essential to further reduce smoking-related tuberculosis burden.

Key words: Tuberculosis, Smoking, Disease burden, Epidemiologic studies

CLC Number:

Xue Yunlian, Li Sijie, Jiang Xue, Liu Guihao, Wu Huizhong, Wang Tingting, Zhou Zhanqi, Ji Lianrong, Wang Jiawen, Wu Xinghua, Wu Yue, Zhou Lin. Global, regional, and national burdens of tuberculosis attributable to smoking from 1990 to 2021[J]. Chinese Journal of Antituberculosis, 2026, 48(9): 1315-1323. doi: 10.19982/j.issn.1000-6621.20250519

Figures/Tables 5

References 36

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