Tuberculosis in older adults (≥ 65 years): Global trends, sex differences, and regional variations, 2000–2023

BACKGROUND: Older adults (≥ 65 years) are at increased risk for tuberculosis (TB), but global burden estimates in this population remain limited. This study analyzes long-term trends from 2000 to 2023 and assesses TB incidence, mortality, and sex-specific differences among older adults. METHODS: Age- and sex-specific TB case data were obtained from the World Health Organization (WHO) Global TB Database and United Nations population estimates. TB incidence and mortality per 100,000 population were calculated for individuals aged ≥ 65 years. Rate ratios (RR) comparing adults ≥ 65 years with the WHO standard adult reference group (individuals aged 15–64 years) were computed. Geographic and sex-specific differences were analyzed using descriptive statistics and choropleth maps. RESULTS: In 2023, individuals aged ≥ 65 years accounted for 21% of global TB cases and 23% of TB deaths. Between 2000 and 2023, TB cases in this age group increased from 610,000 to 947,000, despite declining global TB incidence overall. Rate ratios for incidence and mortality were elevated across all WHO regions, with the highest rate ratios in the Western Pacific and South-East Asia. Men had approximately twice the incidence of TB compared with women. Geographic distribution showed highest burden in South-East Asia, sub-Saharan Africa (influenced by the human immunodeficiency virus–TB co-epidemic), and Eastern Europe (driven partly by multidrug-resistant -TB). CONCLUSIONS: TB burden among older adults is substantial and has increased over the past two decades. Clear sex-specific disparities persist. Age- and sex-tailored public health strategies—including targeted screening, integration of comorbidity management, and strengthened surveillance—are essential to reduce TB-related morbidity and mortality in this vulnerable population.