Tuberculosis burden attributable to smoking in China 1990–2021 and projections to 2040: A secondary analysis of GBD 2021 data
INTRODUCTION Smoking is a well-established modifiable risk factor for tuberculosis (TB). However, the evolving smoking-attributable TB burden in China remains to be fully characterized. The objective was to examine temporal trends in the smoking-attributable TB burden in China from 1990 to 2021. METHODS A secondary analysis was conducted on the 2021 Global Burden of Disease Study data. Data on the number of deaths and disability adjusted life years (DALYs) due to smoking-attributable TB, as well as age-standardized rates, were extracted for the overall Chinese population, males, and females from 1990 to 2021. Joinpoint regression and age-period-cohort analyses described 32-year trends. A Bayesian age-period-cohort (BAPC) model was used to forecast the TB burden from 2022 to 2040. Drivers behind the burden trends were investigated through a decomposition analysis. RESULTS Between 1990 and 2021, TB deaths, DALYs, age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) showed significant reductions, with the ASMR and ASDR declining from 5.10/100000 (95% UI: 3.64–6.73) and 158.48/100000 (95% UI: 114.49–203.94) in 1990 to 0.52/100000 (95% UI: 0.37–0.76) and 19.15/100000 (95% UI: 13.85–26.70) in 2021, respectively. Declines in ASMR (-95.26% vs -89.35%) and ASDR (-93.69% vs -87.35%) were larger in females than in males. Age-period-cohort analyses revealed that mortality and DALY rates peaked at ages 30–34 years and then declined. Male mortality increased slightly at ages 65–69 years. Both period and cohort effects demonstrated consistent downward trends. BAPC projections indicated that after 2022, deaths and DALYs would decline initially but rise again, whereas ASMR and ASDR would continue to fall. CONCLUSIONS The smoking-attributable TB burden in China exhibits significant age- and sex-specific patterns. Despite overall attenuation, projected rebounds in deaths by 2040 call for sustained public health interventions.