National and subnational burden of HIV-negative MDR-TB in China, 1990–2023: Spatio-temporal heterogeneity, long-term trends, and projections

BACKGROUND: Human immunodeficiency virus (HIV)-negative Multidrug-resistant Tuberculosis (MDR-TB) remains a major public health threat in China, Geographic heterogeneity and poorly understood epidemiological trends limit precision control and resource optimization. METHODS: This study systematically assessed the disease burden of HIV-negative MDR-TB in China and its provinces from 1990 to 2023, using data from the Global Burden of Disease Study (GBD) 2023 database. The analysis includes 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). The data spans 31 provinces, autonomous regions, municipalities, and the Special Administrative Regions of Hong Kong and Macao. The Joinpoint regression model was used to analyze trends in disease burden from 1990 to 2023 and calculate the average annual percentage change (AAPC) and annual percentage change (APC). In addition, a Bayesian age-period-cohort (BAPC) model was employed to project the disease burden trends from 2024 to 2050. RESULTS: In 2023, the age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of HIV-negative MDR-TB in China were 1.630 per 100,000 population [95% uncertainty interval (UI): 0.196, 4.967] and 2.740 per 100,000 population (95% UI: 0.340, 8.794), respectively. From 1990 to 2023, ASIR declined significantly [AAPC = -2.859%, 95% confidence interval(CI): -3.487, -2.231], whereas ASPR increased significantly (AAPC = 7.800%, 95% CI: 7.022, 8.578); however, recent trends suggested stabilization, with ASIR plateauing from 2016 to 2023 (AAPC=-0.270%, 95%UI: -1.275, 0.746) and ASPR showing no significant change from 2017 to 2023 (APC = 0.503%, 95% CI: -1.635, 2.687). In 2023, age-standardized mortality rate (ASMR), age-standardized Disability-adjusted life years rate (ASDR), age-standardized Years of Life Lost rate(ASYLLR), and age-standardized Years Lived with Disability rate (ASYLDR) were 0.098 per 100,000 population (95% UI: 0.011, 0.354. AAPC = -6.714%, 95% CI: -7.265, -6.164), 3.718 per 100,000 population (95% UI: 0.466, 13.091. AAPC = -6.633%, 95% CI: -7.130, -6.135), 2.837 per 100,000 population (95% UI: 0.331, 10.333. AAPC = -6.633%, 95% CI: -7.130, -6.135), and 0.881 per 100,000 population (95% UI: 0.118, 2.943. AAPC = -1.614%, 95% CI: -2.366, -0.862), respectively, with significant long-term declines. ASIR (AAPC=0.160%, 95% CI: 0.137, 0.183) and ASPR (AAPC=0.086%, 95% CI: 0.073, 0.098) are forecasted to rise from 2024 to 2050 in China. CONCLUSION: Persistent HIV-negative MDR-TB challenges in China, including rising prevalence and spatial heterogeneity, demand a sustainable model combining policy, AI diagnostics, and community engagement.