Jiawei He

57201492225

Publications - 4

Global burden of lower respiratory infections and aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Usha Adiga Emad M. Abdallah Dariush Abtahi Meriem Abdoun Eman Abu-Gharbieh Siddig Ibrahim Abdelwahab Anurag Agrawal Anirudh Balakrishna Acharya Mohd Adnan Victor Adekanmbi Asrat Agalu Abejew Samar Abd Elhafeez Jeza Muhamad Abdul Aziz Ripon Kumar Adhikary Nermeen Abu-Elala Auwal Abdullahi Khurshid Ahmad Rana Kamal Abu Farha Isaac Yeboah Addo Ahmad Y. Abuhelwa Nadin M.I. Abdel Razeq Sherief Abd-Elsalam Swetha Acharya Williams Agyemang-Duah Lucien R. Swetschinski Charles Oluwaseun Adetunji Juliana Bunmi Adetunji Lisa C. Adams Usman Abubakar Fuad Hamdi A. Abuadas Ali Ahmadi Ashraf Nabiel Abdalla Bright Opoku Ahinkorah Nurudeen A. Adegoke Deldar Morad Abdulah Jiawei He Austin Carter Danish Ahmad Atef Abdelkader Meshack Achore Olumide Thomas Adeleke Olifan Zewdie Abil Armita Abedi Dina Abushanab Mostafa M. Abdrabou Eve E. Wool David Adedia Kamoru Ademola Adedokun Percival Delali Delali Agordoh Muayyad M. Ahmad Aqeel Ahmad Qorinah Estiningtyas Sakilah Adnani Miracle Ayomikun Adesina Hedayat Abbastabar Tauseef Ahmad Ulric Sena Abonie Rabbiya Ahmad Hasan Aalruz Mohammed Altigani Abdalla Atman Adiba Chieh Han Sajjad Ahmad Mache Tsadik Adhana Rose Grace Bender Giuseppina Affinito Richard Gyan Aboagye Mohammad Amin Aalipour Sarah Brooke Sirota Mahnaz Ahmadi Navidha Aggarwal Ahmed A.J. Jabbar Ridwan Olamilekan Adesola Arman Abdous Nagah M. Abourashed Zhanar Abu Toufik Abdul-Rahman Mahsa Ahadi Ousman Adal Gizachew Beykaso Agafari Regina Mae Villanueva Dominguez Hana J. Abukhadijah Abdullahi Tunde Aborode Rabbiya Ahmad Daniel T. Araki Hassan Abolhassani Aminu Kende Abubakar Idowu Peter Adewumi Nermeen Abu-Elala Habtamu Abebe Getahun None Abdullah Faisal Ahmad Syed Hani Abidi Zahra Abbasi Dolatabadi Tajudeen Adesanmi Adebisi Kulmira Abdykerimova Qorinah Estiningtyas Sakilah Adnani Amanda Movo Hasan Aalruz Nagah M. Abourashed Zhanar Abu Atman Adiba Atef Abdelkader Krishna Prasad Acharya Adamu Adamu Ahmad Ijaz Ahmad Olumide Abiodun Saira Afzal Ali Ahmed

Publication Name: Lancet Infectious Diseases

Publication Date: 2026-04-01

Volume: 26

Issue: 4

Page Range: 343-361

Description:

Background: Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Methods: Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. Findings: In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24–2·81) deaths and 98·7 million (87·7–112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4–47·4) since 2010, with a global mortality rate of 94·8 (75·6–116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000–721 000] deaths or 25·3% [24·5–26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000–298 000] deaths or 10·9% [10·3–11·3]), and Klebsiella pneumoniae (228 000 [204 000–261 000] deaths or 9·1% [8·8–9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000–201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900–75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. Interpretation: This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies—including newer interventions such as respiratory syncytial virus monoclonal antibodies—and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Funding: Gates Foundation.

Open Access: Yes

DOI: 10.1016/S1473-3099(25)00689-9

Global burden of enteric infectious diseases, diarrhoeal diseases, and corresponding aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Usha Adiga Emad M. Abdallah Dariush Abtahi Eman Abu-Gharbieh Amr Selim Abu Lila Siddig Ibrahim Abdelwahab Rashad Abdul-Ghani Anirudh Balakrishna Acharya Mohd Adnan Lorainne Tudor Car Victor Adekanmbi Reda Abdel-Hameed Asrat Agalu Abejew Ayo Stephen Adebowale Samar Abd Elhafeez Jeza Muhamad Abdul Aziz Ripon Kumar Adhikary Muhammad Sohail Afzal Nermeen Abu-Elala Auwal Abdullahi Rana Kamal Abu Farha Isaac Yeboah Addo Ahmad Y. Abuhelwa Victor Ibukun Agbajelola Zeleke Dutamo Agde Obed Adonteng-Kissi Piyush Agrawal Swetha Acharya Charles Oluwaseun Adetunji Lisa C. Adams Fuad Hamdi A. Abuadas Madineh Abbasi Omar Ahmed Abdelwahab Nurudeen A. Adegoke Jiawei He Makinde Adebayo Adeniyi Austin Carter Abdu A. Adamu Rezheen Fatah Abdulrahman Olumide Thomas Adeleke Feleke Doyore Agide Babatope Oluwadamilare Adebiyi Olifan Zewdie Abil Samuel B. Albertson Dina Abushanab Sawsan Abuhammad David Adedia Kamoru Ademola Adedokun Percival Delali Delali Agordoh A. Bhoomadevi Catherine Bisignano Qorinah Estiningtyas Sakilah Adnani Oluwawemimo Oluseun Adebowale Ebenezer Afrifa-Yamoah Hasan Aalruz Avina Vongpradith Samuel M. Ostroff Richard Gyan Aboagye Molalign Aligaz Aligaz Adisu Melese Shenkut Abebe Navidha Aggarwal Rizwan Suliankatchi Abdulkader Arman Abdous Nagah M. Abourashed Toufik Abdul-Rahman Belete Muluadam Admassie Regina Mae Villanueva Dominguez Hana J. Abukhadijah Abdullahi Tunde Aborode Abdulrakib Abdulrahim Abdelmuhsin Abdelgadir Hassan Abolhassani Adedeji Adenusi Saheed Ayodeji Adekola Yirgalem Abere Shairyar Afzal Oluwatobi E. Adegbile None Abdullah Sadik Abdulwehab Belayneh Jejaw Abate Aishah Fadila Adamu Syed Hani Abidi Tajudeen Adesanmi Adebisi Kulmira Abdykerimova Wakgari Mosisa Abdisa Alqassem H. Abuarqoub Ahmed Abdelrahman Abdelgalil Amanda Movo Rofiat Adewumi Adewumi Aderinoye-Rabiu Hasan Aalruz Krishna Prasad Acharya Meklit Girma Abebe Abdulbasit Sherfa Abduljelil Bhoomadevi A Ahmed AH Abdellatif Nermeen Abu-Elala Adekola George Adepoju Zirak Ahmed Abdulrahman Kalkidan Yibeltal Admassu Yau Adamu Nagah M. Abourashed Daniel Adeyemi Adepoju Olumide Abiodun Saira Afzal

Publication Name: Lancet Infectious Diseases

Publication Date: 2026-01-01

Volume: Unknown

Issue: Unknown

Page Range: Unknown

Description:

Background: Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. Methods: We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. Findings: In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963–1·68) deaths globally, declining from 3·69 million (3·04–4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0–92·9) per 100 000 population to 16·4 (12·6–21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811–1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000–882 000) and 501 000 (373 000–648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0–21·5]), followed by norovirus (10·2% [2·4–17·0]) and Shigella spp (9·3% [5·4–15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5–48·5) for rotavirus, 24·0% (15·1–36·7) for Shigella spp, and 23·4% (13·7–34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290–49 000) and 18 800 (4650–44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Interpretation: Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Funding: Gates Foundation.

Open Access: Yes

DOI: 10.1016/S1473-3099(26)00194-5

Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023

Catherine Bisignano Ashley A. Harris Amanda E. Smith Paulina A. Lindstedt Simeon Okechukwu Ajakwe Olivia D. Nesbit Taylor Noyes Noga Shalev Latera Tesfaye Olana Catherine M. Antony Nancy Fullman Sharareh Eskandarieh Mushood Ahmed Naveed Ahmed Rana Kamal Abu Farha Kamoru Ademola Adedokun Nurudeen A. Adegoke Aanuoluwapo Adeyimika Afolabi Giuseppina Affinito Dolapo Emmanuel Ajala Eman Abu-Gharbieh Reed J.D. Sorensen Chun Wei Yuan Stein Emil Vollset Stephen S. Lim Jonathan F. Mosser Andy Stergachis Farbod Khosravi Sonali Kochhar Armita Abedi Usha Adiga Mitra Abbasifard Mohammad Amin Aalipour Faezeh Abbaspour Tomislav Mestrovic Dariush Abtahi Ripon Kumar Adhikary Mohd Adnan Aqeel Ahmad Simon I. Hay Abdollah Jafarzadeh Williams Agyemang-Duah Hana J. Abukhadijah Danish Ahmad Amin Sharifan Rotimi Felix Afolabi Saira Afzal Emad M. Abdallah Samar Abd Elhafeez Meqdad Saleh Ahmed Muktar Beshir Ahmed Syed Anees Ahmed Suneth Buddhika Agampodi Khurshid Ahmad Tauseef Ahmad Sepehr Aghajanian Ayman Ahmed Ramy Mohamed Ghazy Meriem Abdoun Salahdein Aburuz Lucas Guimarães Abreu Alireza Shakeri Qorinah Estiningtyas Sakilah Adnani Emily Haeuser Sam Byrne Jason Nguyen Catalina Raggi Susan A. McLaughlin Hedayat Abbastabar Rana Kamal Abu Farha Sherief Abd-Elsalam Dmitry Abramov Adam Abdullahi Faezeh Abbaspour Reda Abdel-Hameed Samar Abd ElHafeez Atef Abdelkader Deldar Morad Abdulah Haroon Ahmed Lisa C. Adams Toufik Abdul-Rahman Constanza Elizabeth Aguilera Arriagada Mahsa Ahadi Rabbiya Ahmad Shoaib Ahmad Asrat Agalu Abejew Abdu A. Adamu Juliana Bunmi Adetunji Kulmira Abdykerimova Rahim Abo Kasem Nagah M. Abourashed Mohamed Abouzid Roberto Ariel Abeldaño Zuñiga Juan Manuel Acuna Anirudh Balakrishna Acharya Meshack Achore Ousman Adal Habeeb Abiodun Afolabi Hasan Aalruz Arman Abdous Auwal Abdullahi Bilyaminu Abubakar David Adedia Syed Hani Abidi Olumide Abiodun Hassan Abolhassani Richard Gyan Aboagye Ulric Sena Abonie Abdullahi Tunde Aborode Wakgari Mosisa Abdisa Oyelola A. Adegboye Mohammad Mahdi Bastan Dhiraj Motilal Agarwal Tajudeen Adesanmi Adebisi Oluwatobi E. Adegbile Olumide Thomas Adeleke Mache Tsadik Adhana Molalegne Bitew Feven Sahle Gebre Leticia Akua Adzigbli Alireza Mirkheshti Sohrab Salimi Seyed Mohammad Seyed Alshohadaei Hafsa Zia Gizachew Taddesse Akalu Jiawei He Prince Owusu Adoma Dorsa Salabat Mohamed Jalloh Vafa Rahimi-Movaghar Sina Shool Melika Jameie Jafar Karami Farzad Kompani Mohammad Ali Mansournia Abdolreza Mohammadi Amin Mohsenzadeh Aleksandr Y. Aravkin Omid Dadras Iman M. Talaat Ali H. Mokdad Xiaochen Dai Lalit Dandona Rakhi Dandona Sara Bagheri Fereshteh Baghizadeh Mahdis Bayat Minoo Heidari Almasi Ali Asghar Kolahi Ali Nikoobar Mohammad Mahdi Rashidi Firoozeh Madadi Mehdi Safari Mastooreh Sagharichi Maryam Shayan Georgia Smith Samuel James Herold Annie Haakenstad Christopher J.L. Murray Zahra Siavashpour Mohsen Rezaeian Shakiba Ghasemi Assl Atakan Orscelik Yigit Can Senol Michael Zastrozhin Hannah Elizabeth Robinson-Oden Amin Azizan Nazila Rezaei Pegah Salimi Pormehr Amin Sedigh Farshad Shahkarami Kazem Ghaffari Ghazal Arjmand Mahsa Asadi Anar Rasoul Ebrahimi Seyed Ataollah Madinezad Behnaz Niroomand Seyed Kiarash Sadat Rafiei Antonio Olivas-Martinez

Publication Name: Lancet

Publication Date: 2025-07-19

Volume: 406

Issue: 10500

Page Range: 235-260

Description:

Background: Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030. Findings: Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. Coverage gains slowed between 2010 and 2019 in many countries and territories, including declines in 21 of 36 high-income countries and territories for at least one of these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1–77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6–20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6–17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities. Interpretation: Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals. Funding: The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

Open Access: Yes

DOI: 10.1016/S0140-6736(25)01037-2

Global, regional, and national burden of tuberculosis and multidrug-resistant tuberculosis by HIV status, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Usha Adiga Emad M. Abdallah Meriem Abdoun Eman Abu-Gharbieh Amr Selim Abu Lila Siddig Ibrahim Abdelwahab Rashad Abdul-Ghani Anirudh Balakrishna Acharya Mohd Adnan Victor Adekanmbi Dhiraj Motilal Agarwal Asrat Agalu Abejew Samar Abd Elhafeez Jeza Muhamad Abdul Aziz Ripon Kumar Adhikary Muhammad Sohail Afzal Auwal Abdullahi Ukachukwu O. Abaraogu Rana Kamal Abu Farha Isaac Yeboah Addo Bilyaminu Abubakar Ahmad Y. Abuhelwa Olatunji O. Adetokunboh Ali Abuhaliema Obed Adonteng-Kissi Lawan Hassan Adamu Sherief Abd-Elsalam Swetha Acharya Williams Agyemang-Duah Mei Fong Liew Charles Oluwaseun Adetunji Juliana Bunmi Adetunji Aseel Aburub Deldar Morad Abdulah Abiola Victor Adepoju Jiawei He Makinde Adebayo Adeniyi Abdu A. Adamu Rezheen Fatah Abdulrahman Olumide Thomas Adeleke Feleke Doyore Agide Jorge R. Ledesma Babatope Oluwadamilare Adebiyi Olifan Zewdie Abil Sawsan Abuhammad Kamoru Ademola Adedokun Percival Delali Delali Agordoh Oluwawemimo Oluseun Adebowale Arailym Abilbayeva Ebenezer Afrifa-Yamoah Yasir M. Abdulateef Abdul Momin Rizwan Ahmad Mai Abdel Haleem Abusalah Aanuoluwapo Adeyimika Afolabi Samuel M. Ostroff Richard Gyan Aboagye Molalign Aligaz Aligaz Adisu Shimaa M. Aboelnaga Huong Thi Chu Navidha Aggarwal Wondimnew Desalegn Addis Ridwan Olamilekan Adesola Ali Abdolizadeh Arman Abdous Nagah M. Abourashed Prince Owusu Adoma Gizachew Beykaso Agafari Belete Muluadam Admassie Regina Mae Villanueva Dominguez Hana J. Abukhadijah Abdullahi Tunde Aborode Meixin Zhang Jianing Ma Abdulrakib Abdulrahim Hassan Abolhassani Saheed Ayodeji Adekola Sophie Mei Lin Whikehart Oluwatobi E. Adegbile Habtamu Abebe Getahun Nuhu Lawan Adamu None Abdullah Sadik Abdulwehab Belayneh Jejaw Abate Megan Verma Syed Hani Abidi Tajudeen Adesanmi Adebisi Wakgari Mosisa Abdisa Amanda Movo Mahdi Aghaalikhani Yasir M. Abdulateef Krishna Prasad Acharya Adamu Adamu Ahmad Hassan A. Abdou Zirak Ahmed Abdulrahman Nagah M. Abourashed Hatem A Eltaly Mazhar Abbas Vijay K. Aggarwal Adnan Ahmad Nermeen Abu-Elala Olumide Abiodun Saira Afzal

Publication Name: Lancet Infectious Diseases

Publication Date: 2026-01-01

Volume: Unknown

Issue: Unknown

Page Range: Unknown

Description:

Background: Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. Methods: We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. Findings: In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04–10·3) incident cases of all-form TB, 1·22 million (0·98–1·49) deaths, and 54·6 million (43·8–65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000–879 000) incident cases and 210 000 (142 000–279 000) deaths, contributing 11·0 million (7·56–14·3) DALYs. MDR-TB accounted for 466 000 (198 000–1 080 000) incident cases, 102 000 (31 700–238 000) deaths, and 3·96 million (1·31–9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8–20·5) and deaths declined by 22·6% (4·7–35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000–970 000) and DALYs to 34·9 million (27·8–43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400–183 000) and DALYs to 3·12 million (1·03–7·29). Interpretation: Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. Funding: Gates Foundation.

Open Access: Yes

DOI: 10.1016/S1473-3099(26)00295-1