The disease burden and changing trends of HIV/AIDS-associated drug-susceptible tuberculosis in the elderly population aged 60 above of China from 1990 to 2021

doi:10.19982/j.issn.1000-6621.20250265

Abstract

Abstract:

Objective: To analyze the trends in disability-adjusted life years (DALYs), deaths, incidence, and prevalence of HIV/AIDS co-infected with drug-susceptible tuberculosis (DS-TB) among the elderly aged 60 above in China from 1990 to 2021, and to provide reference for the formulation of prevention and control strategies. Methods: Data on DALYs, deaths, incidence, and prevalence of HIV/AIDS co-infected with DS-TB among individuals aged ≥60 years in China from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) database. The estimated annual percentage change (EAPC) and its 95% confidence interval (CI) were used to describe the dynamic trends of each indicator. Results: From 1990 to 2021, the prevalence and incidence of HIV/AIDS co-infected with DS-TB among the elderly in China continued to rise, with the most pronounced increase observed in the 80-84 age group, recording an EAPC of 3.77% (95%CI: 2.33%-5.22%). Mortality and DALYs showed heterogeneous trends: while mortality declined in those aged ≥80, DALYs increased in absolute terms across all age groups except the 90-94 cohort, with the fastest growth in the 70-74 age group (EAPC=1.71%, 95%CI: 0.27%-3.18%). In 2021, the 65-69 age group bore the heaviest disease burden, ranking highest across all indicators—DALYs, deaths, incidence, and prevalence. Among males, these were 45.6757 million person-years, 1.516 million deaths, 11.074 million incident cases, and 23.3058 million prevalent cases, respectively; among females, they were 16.4134 million person-years, 0.5264 million deaths, 4.2574 million incident cases, and 9.051 million prevalent cases. All indicators were significantly higher in males than in females. Beyond this age group, all four indicators declined with advancing age. Attributable mortality due to behavioral risks and unsafe sex among males increased with age, reaching 86.22/100000 and 83.38/100000, respectively, in those ≥95 years. Among females, attributable mortality from both behavioral risks and unsafe sex exceeded 90/100000. Conclusion: The disease burden of HIV/AIDS co-infected with DS-TB among the elderly in China is steadily increasing, with causes involving behavior, drugs, and violence. Greater attention should be paid to the very old and to sex-specific differences in future prevention and control efforts.

Key words: Aged, HIV infections, Tuberculosis, Comorbidity, Disease attributes

CLC Number:

R52
R211

Zhu Qingdong, Zhao Chunyan, Huang Aichun, Zeng Chunmei, Gong Chunming, Xu Chaoyan, Jian Shasha, Li Weiwen, Song Chang. The disease burden and changing trends of HIV/AIDS-associated drug-susceptible tuberculosis in the elderly population aged 60 above of China from 1990 to 2021[J]. Chinese Journal of Antituberculosis, 2026, 48(1): 34-40. doi: 10.19982/j.issn.1000-6621.20250265

Figures/Tables 6

References 18

[1]	Zhang SX, Wang JC, Yang J, et al. Epidemiological features and temporal trends of the co-infection between HIV and tuberculosis, 1990—2021: findings from the Global Burden of Disease Study 2021. Infect Dis Poverty, 2024, 13(1): 59. doi:10.1186/s40249-024-01230-3.
[2]	Zhou R, Zheng YJ, Wang BJ, et al. Development and validation of the patient-reported outcome for older people living with HIV/AIDS in China (PROHIV-OLD). Health Qual Life Outcomes, 2024, 22(1): 30. doi:10.1186/s12955-024-02243-0.
[3]	国务院第七次人口普查领导小组办公室. 中国人口普查年鉴—2020[EB/OL].[2025-06-20]. https://www.stats.gov.cn/sj/pcsj/rkpc/7rp/indexch.htm.
[4]	Sun R, Wang L, Xia H. Disease burden of tuberculosis in China from 1990 to 2021 and its prediction to 2036. Front Public Health, 2025, 12:1506266. doi:10.3389/fpubh.2024.1506266.
[5]	Liu X, Yang Q, Pan L, et al. Burden of respiratory tract cancers in China and its provinces, 1990—2021: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Reg Health West Pac, 2025, 55: 101485. doi:10.1016/j.lanwpc.2025.101485.
[6]	Wang L, Lv H, Zhang X, et al. Global prevalence, burden and trend in HIV and drug-susceptible tuberculosis co-infection from 1990 to 2019 and prediction to 2040. Heliyon, 2024, 10(1): e23479. doi:10.1016/j.heliyon.2023.e23479.
[7]	张梦迪, 王鑫, 郑文静, 等. 老年结核病危险因素研究进展. 中国防痨杂志, 2024, 46(10): 1266-1272. doi:10.19982/j.issn.1000-6621.20240255.
[8]	Liu E, Wang Q, Zhang G, et al. Tuberculosis/HIV Coinfection and Treatment Trends-China, 2015-2019. China CDC Wkly, 2020, 2(48): 924-928. doi:10.46234/ccdcw2020.252.
[9]	Hou Y, Jin Y, Cai C, et al. Comparative Analysis of Epidemio-logical Features of HIV/AIDS Cases Aged Over and Under 50 Years Old-China, 2010—2022. China CDC Wkly, 2023, 5(48): 1079-1083. doi:10.46234/ccdcw2023.202.
[10]	Zhang R, Pu J, Zhou J, et al. Factors predicting self-report adherence (SRA) behaviours among DS-TB patients under the “Integrated model”: a survey in Southwest China. BMC Infect Dis, 2022, 22(1): 201. doi:10.1186/s12879-022-07208-6. pmid: 35232384
[11]	Khan J, Greaves E, Tanton C, et al. Sexual behaviours and sexual health among middle-aged and older adults in Britain. Sex Transm Infect, 2023, 99(3): 173-179. doi:10.1136/sextrans-2021-055346.
[12]	Ren N, Li Y, Wan Z, et al. Patterns of HIV or AIDS Mortality Among Older People From 1990 to 2019 in China: Age-Period-Cohort Analysis. JMIR Public Health Surveill, 2022, 8(11): e35785. doi:10.2196/35785.
[13]	Zhang SX, Zheng JX, Wang Y, et al. Trend and forecast analysis of the changing disease burden of tuberculosis in China, 1990—2021. Epidemiol Infect, 2025, 153: e85. doi:10.1017/S0950268825100095.
[14]	Horton KC, MacPherson P, Houben RM, et al. Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. PLoS Med, 2016, 13(9): e1002119. doi:10.1371/journal.pmed.1002119.
[15]	吕成彬. 2010—2022年浙江省永康市男男性行为人群艾滋病流行情况分析. 中国实用乡村医生杂志, 2024, 31(10): 6-8. doi:10.3969/j.issn.1672-7185.2024.10.003.
[16]	陈卉, 孙彦波, 沈鑫, 等. 老年人群肺结核主动发现及患者特征分析. 中国防痨杂志, 2021, 43(6): 550-556. doi:10.3969/j.issn.1000-6621.2021.06.006.
[17]	马平, 廖龙玉, 张容静, 等. 广西农村老年人发生艾滋病相关高危性行为的影响因素. 广西医学, 2024, 46(12): 1807-1814. doi:10.11675/j.issn.0253-4304.2024.12.02
[18]	Krishnan L, Akande T, Shankar AV, et al. Gender-related barriers and delays in accessing tuberculosis diagnostic and treatment services: a systematic review of qualitative studies. Tuberc Res Treat, 2014, 2014: 215059. doi:10.1155/2014/215059.

年龄组 (岁)	1990年		2021年		EAPC (%,95%CI)
年龄组 (岁)	死亡数 (万例,95%CI)	死亡率 (/10万,95%CI)	死亡数 (万例,95%CI)	死亡率 (/10万,95%CI)	EAPC (%,95%CI)
60~64	45(1~75)	0.13(0~0.21)	159(93~240)	0.22(0.13~0.33)	0.78(-0.35~1.92)
65~69	34(1~57)	0.13(0~0.21)	204(118~316)	0.27(0.15~0.41)	0.57(-0.63~1.79)
70~74	19(1~32)	0.10(0~0.17)	141(82~216)	0.26(0.15~0.41)	1.30(-0.26~2.89)
75~79	25(6~38)	0.22(0.05~0.33)	92(53~142)	0.28(0.16~0.43)	1.05(0.08~2.02)
80~84	4(1~13)	0.08(0.02~0.24)	41(23~63)	0.21(0.12~0.32)	-0.97(-2.68~0.78)
85~89	1(0~4)	0.08(0.02~0.26)	19(11~30)	0.20(0.12~0.31)	-0.76(-2.41~0.93)
90~94	0(0~1)	0.07(0.02~0.22)	4(2~7)	0.14(0.08~0.22)	-1.62(-3.22~0.02)
≥95	0(0~0)	0.05(0.02~0.14)	1(0~1)	0.11(0.07~0.18)	-1.66(-3.22~-0.07)

年龄组 (岁)	1990年		2021年		EAPC (%,95%CI)
年龄组 (岁)	DALYs (人年,95%CI)	DALYs率 (/10万,95%CI)	DALYs (人年,95%CI)	DALYs率 (1/10万,95%CI)	EAPC (%,95%CI)
60~64	1522(220~2418)	4.31(0.62~6.84)	5600(3581~8132)	7.67(4.91~11.14)	1.02(-0.02~2.08)
65~69	992(153~1565)	3.64(0.56~5.73)	6209(3971~9026)	8.09(5.18~11.77)	0.94(-0.16~2.06)
70~74	485(93~768)	2.58(0.49~4.08)	3647(2397~5252)	6.84(4.50~9.85)	1.71(0.27~3.18)
75~79	639(375~800)	5.62(3.29~7.03)	2037(1312~2884)	6.15(3.96~8.71)	1.15(0.33~1.98)
80~84	65(22~205)	1.22(0.42~3.87)	805(535~1117)	4.07(2.70~5.64)	0.17(-1.39~1.75)
85~89	17(6~57)	1.00(0.33~3.37)	313(212~436)	3.29(2.22~4.58)	0.37(-1.12~1.88)
90~94	2(1~8)	0.81(0.27~2.60)	70(48~95)	2.39(1.64~3.25)	-0.02(-1.47~1.44)
≥95	0(0~1)	0.61(0.22~1.74)	12(8~16)	1.88(1.31~2.51)	0.13(-1.24~1.52)

年龄组 (岁)	1990年		2021年		EAPC (%,95%CI)
年龄组 (岁)	患病数 (万例,95%CI)	患病率 (/10万,95%CI)	患病数 (万例,95%CI)	患病率 (/10万,95%CI)	EAPC (%,95%CI)
60~64	574(399~694)	1.62(1.13~1.96)	2591(2122~3001)	3.55(2.91~4.11)	2.65(2.07~3.25)
65~69	391(266~470)	1.43(0.98~1.72)	3236(2640~3751)	4.22(3.44~4.89)	2.98(2.21~3.77)
70~74	272(173~339)	1.45(0.92~1.80)	2159(1765~2508)	4.05(3.31~4.71)	3.51(2.26~4.77)
75~79	604(326~995)	5.30(2.87~8.75)	1515(1240~1761)	4.57(3.74~5.32)	1.72(0.73~2.72)
80~84	36(7~119)	0.67(0.13~2.26)	793(652~920)	4.01(3.29~4.65)	3.77(2.33~5.22)
85~89	10(2~34)	0.61(0.12~2.01)	320(263~371)	3.36(2.76~3.89)	3.54(2.14~4.95)
90~94	2(0~6)	0.56(0.11~1.85)	84(69~97)	2.87(2.35~3.32)	3.21(1.83~4.60)
≥95	0(0~1)	0.52(0.11~1.62)	15(12~18)	2.36(1.94~2.74)	2.92(1.57~4.29)

年龄组 (岁)	1990年		2021年		EAPC (%,95%CI)
年龄组 (岁)	发病数 (万例,95%CI)	发病率 (/10万,95%CI)	发病数 (万例,95%CI)	发病率 (/10万,95%CI)	EAPC (%,95%CI)
60~64	380(278~449)	1.07(0.79~1.27)	1243(1052~1414)	1.70(1.44~1.94)	1.58(1.17~2.00)
65~69	260(174~306)	0.95(0.64~1.12)	1533(1302~1743)	2.00(1.70~2.27)	1.89(1.28~2.50)
70~74	182(140~217)	0.97(0.74~1.15)	1024(869~1164)	1.92(1.63~2.18)	2.37(1.30~3.44)
75~79	458(303~614)	4.03(2.67~5.40)	717(607~816)	2.17(1.83~2.46)	0.41(-0.57~1.41)
80~84	25(7~68)	0.46(0.13~1.28)	377(320~429)	1.91(1.61~2.17)	2.15(0.52~3.80)
85~89	7(2~19)	0.42(0.12~1.14)	153(130~174)	1.61(1.36~1.83)	1.92(0.35~3.52)
90~94	1(0~3)	0.40(0.11~1.07)	40(34~46)	1.38(1.17~1.56)	1.58(0.03~3.14)
≥95	0(0~0)	0.38(0.12~0.94)	7(6~8)	1.15(0.98~1.31)	1.38(-0.09~2.87)