Tuberculosis incidence and mortality trends in mainland China, 2004-2024: control program and elimination progress

The global tuberculosis (TB) epidemic imposes a substantial burden. As a high-burden country, China faces a significant gap from the World Health Organization (WHO)'s 2025-2030 TB prevention and control targets. This study analyzed the temporal trends of TB epidemiology in mainland China to provide an evidence base for the early achievement of TB control goals.

We integrated TB surveillance data (2004-2024) from the National Health Commission of the People's Republic of China and population data from the National Bureau of Statistics. Joinpoint regression was used to identify trend changes, with the average annual percent change (AAPC) quantifying trend magnitudes. Interrupted time series model was applied to assess intervention effects, and seasonal autoregressive integrated moving average models were employed to predict future incidence and mortality trends.

A total of 19.4854 million cumulative TB cases and 508,000 cumulative deaths were reported during 2004-2024. The incidence rate decreased from 74.644 to 49.888 per 100,000 population (AAPC = - 2.83%, P < 0.001), showing a "winter peak and summer trough" pattern-with a 32.7% higher incidence in winter than in summer. The mortality rate first decreased and then increased: it declined immediately after the full coverage of Directly Observed Treatment, Short-course in 2010 but rose to 0.283 per 100,000 population after 2021. Projections indicate that the achievement rate of the WHO incidence target will be only 43.24% by 2025 (target: 31.708 per 100,000 population) and 39.48% by 2030 (target: 12.683 per 100,000 population). The mortality rate is projected to reach 0.333 per 100,000 population by 2030, compared with the target of 0.013 per 100,000 population.

Despite notable achievements in TB control in China, significant gaps remain from the WHO's targets. It is imperative to strengthen precision stratification-based prevention and control, establish a TB diagnosis and treatment guarantee mechanism, and implement remote supervision relying on informatization.