Objective To analyze the disease burden caused by tuberculosis (TB) and its trend in China from 1990 to 2021.

Methods Data of the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of TB in China between 1990 and 2021 were extracted from the Global Burden of Disease 2021 database. The average annual percentage change (AAPC) was calculated to describe trends in disease burden. Bayesian age-period-cohort model was used to predict the incidence and mortality rates of TB in China from 2022 to 2035.

Results From 1990 to 2021, age-standardized incidence rate AAPC= −3.78%, 95% confidence interval (CI): −3.90 − −3.66%, mortality rate (AAPC= −7.79%, 95%CI: −8.07% − −7.30%), and DALY rate (AAPC= −7.49%, 95%CI: −7.71% − −7.26%) of TB showed declining trendsin China. Similarly, the age-standardized incidence rate (AAPC= −6.60%, 95% CI: −7.85% − −5.33%), mortality rate (AAPC= −8.06%, 95%CI: −9.26% − −6.84%), and DALY rate (AAPC= −10.07%, 95%CI: −11.29% − −8.84%) of multidrug-resistant TB (MDR-TB) also declined. However, between 2022 and 2035, the age-standardized incidence rate and mortality rate of extensively drug-resistant TB (XDR-TB), HIV associated drug-sensitive TB, HIV-associated MDR-TB, and HIV-associated XDR-TB are predicted to increase.

Conclusion The disease burden caused by TB mitigated in China from 1990 to 2021. However, drug-resistant TB and co-infection with HIV pose significant challenges to further reducing the disease burden, necessitating the targeted prevention and control.