Trends in the burden of pulmonary tuberculosis among older adults in Western China, 2005-2020

Background Western China is a priority region for tuberculosis control, yet temporal trends and shifts in the composition of pulmonary tuberculosis (PTB) burden among older adults remain insufficiently explored amid rapid population aging. Methods Incidence data were obtained from the Tuberculosis Information Management System, mortality data from the National Disease Surveillance Points system, and population data from the China Disease Prevention and Control Information System for 12 western provincial-level regions from 2005 to 2020. Prevalence for 2005–2020 was estimated using DisMod II based on 2010 survey prevalence and corresponding incidence and mortality. Age standardization was done using the 2010 national census. DALYs (including YLLs and YLDs) were calculated using WHO methods, the GBD 2019 life table, and China-specific disability weights. Joinpoint regression estimated the annual percent change (APC) and average annual percent change (AAPC). Analyses used aggregated, anonymized data stratified by predefined 5-year age groups (60–64, 65–69, 70–74, 75–79, 80–84, and ≥ 85 years), sex, and residence (urban/rural). Results The age-standardized mortality rate declined from 62.28 to 10.93 per 100,000 (AAPC = − 8.56%, P < 0.001). Declines in incidence (172.29 to 113.10 per 100,000; AAPC = − 2.91%, P = 0.068) and prevalence (1,036.32 to 801.03 per 100,000; AAPC = − 1.97%, P = 0.299) were not statistically significant. The age-standardized DALYs rate decreased from 1,560.10 to 496.26 per 100,000 (AAPC = − 5.42%, P < 0.001), driven by YLLs reduction (1,170.99 to 194.66 per 100,000; AAPC = − 8.87%, P < 0.001); meanwhile, the proportion of YLDs in DALYs rose from 25.17% to 60.66%. Males bore approximately twice the female burden, and the age-standardized DALYs rate in rural areas in 2020 exceeded that in urban areas by 61%. Decline decelerated with age (AAPC = − 6.47% for 60–64 years and − 3.59% for 80–84 years; both P < 0.001). Conclusions PTB burden among older adults in western China shifted from mortality toward disability between 2005 and 2020. Strengthening post-tuberculosis lung health services and long-term management—particularly in rural settings and the oldest age groups—may warrant consideration.