Abstract:Background Tuberculosis (TB) remains a major global health threat, characterized by highly heterogeneous distributions in disease burden and quality of care (QoC) worldwide. Objectives This study aimed to comprehensively assess the cross-country inequalities in TB burden and QoC at global, regional, and national levels from 1990 to 2021. Materials and Methods Data on TB were derived from the Global Burden of Disease (GBD) 2021 study, covering the globe, five sociodemographic index (SDI) regions, and 204 countries/territories. Disease burden was measured via the age-standardized disability-adjusted life years rate (ASDR). The Quality of Care Index (QCI) is a composite metric calculated through principal component analysis, scaled from 0 to 100, where higher values indicate better quality. Gender disparities were quantified by the Gender Disparity Ratio (GDR), defined as the female-to-male ratio. Cross-country inequalities in ASDR and QCI were evaluated using the Slope Index of Inequality (SII) for absolute disparities and the Concentration Index for relative disparities. Results From 1990 to 2021, the global ASDR of TB decreased from 1,650.59 to 580.26/105, while the age” standardized QCI improved from 54.41 to 66.83. The low-SDI region consistently faced a triple disadvantage: the heaviest TB burden, poorest quality of care, and most pronounced gender disparity in QCI. For ASDR, the SII decreased from -5863.34 to -2587.73, while the Concentration Index increased from -0.6889 to -0.7332, indicating that inequality persisted among lower SDI countries. Regarding QCI, although the Concentration Index decreased from 0.1384 to 0.1152, the SII increased from 42.74 to 45.27, suggesting a worsening inequality trend favoring higher SDI countries. Conclusions Over the past three decades, the global burden of TB has decreased, and care quality has improved. However, significant disparities existed between genders and across SDI regions. Lower SDI countries continued to bear a disproportionately high TB burden and suffer from suboptimal care quality, marked by significant gender disparities.
Keywords: Health Systems and Universal Health Coverage (UHC), inequality, global burden of disease, quality of care, tuberculosis, disability”adjusted life years
