Abstract
Objectives
Tuberculosis (TB), caused by the airborne Mycobacterium tuberculosis (Mtb), requires a treatment of minimum 6 months. About a quarter of the world’s population is infected with Mtb. Globally in 2023, an estimated 10.8 million people fell ill with TB. This report accounts for TB incidence and mortality in 2023 in the Republic of Korea (ROK) and Organisation for Economic Co-operation and Development (OECD) member countries, and globally, based on the Global Tuberculosis Report 2024.
Methods
This report refers to a writing extracted the Global Tuberculosis Report 2024 and analyzed using data downloaded from the World Health Organization (WHO) website.
Results
In 2023, the global TB incidence reached 10.8 million (134 cases per 100,000), and a 0.9% increase from 10.7 million in 2022. TB deaths decreased by 5.3%, falling to 1.25 million from 1.32 million the previous year. The ROK reported a TB incidence rate of 38 cases per 100,000 population and a mortality rate of 3 people per 100,000 population in 2023. Among the 38 OECD member countries, the ROK ranked second in TB incidence and fifth in TB mortality.
Conclusions
In the WHO’s End TB strategy, which targets a 50% reduction in TB incidence and a 75% reduction in TB deaths by 2025 (relative to 2015 levels), the ROK has achieved a 51.9% reduction in TB incidence and a 44.4% reduction in TB deaths by 2023. The ROK enters the aging population, and has increased TB incidence aged 65 or older. So, it is essential to strengthen TB policies focused on early detection, timely-treatment and management continuously.
Keywords: Tuberculosis, World Health Organization, Surveillance, Incidence, Mortality
Key messages
① What is known previously?
In 2022, the Republic of Korea (ROK) ranked second in tuberculosis (TB) incidence and fourth in TB mortality among the 38 Organisation for Economic Co-operation and Development (OECD) member countries.
② What new information is presented?
In 2023, the global TB incidence reached 10.8 million, and a 0.9% increase from 10.7 million in 2022. Meanwhile, TB deaths decreased by 5.3%, from 1.32 million in 2022 to 1.25 million in 2023. The ROK ranked second in TB incidence and fifth in TB mortality among the OECD member countries.
③ What are implications?
By going into the aging population, ROK has increased TB incidence aged 65 or older. So, it is essential to strengthen TB policies focused on early detection, timely-treatment and management continuously.
Introduction
Tuberculosis (TB) is an infectious disease caused by the airborne transmission of the Mycobacterium tuberculosis (Mtb). It is curable if TB disease can be successfully treated with a 6-month drug regimen [1]. Approximately one-quarter of the global population have been infected with Mtb, of which about 5% are likely to develop TB within 2 years of infection with an additional 5% developing the disease over their lifetime [1]. TB will be its status as the world’s leading cause of death from an infectious disease in 2023, having been second only to coronavirus disease 2019 (COVID-19) during the pandemic years of 2020–2022. Moreover, with the aim of “End TB by 2030,” the United Nations (UN) and the World Health Organization (WHO) have established targets to reduce TB incidence by 80% and TB mortality by 90% by 2030, relative to 2015 levels [2,3]. To advance this objective, the UN convened two high-level meetings in 2018 and 2023 to reinforce political commitment towards tackling TB [4,5]. Since 1997, the WHO has annually published the “Global Tuberculosis Report,” offering a comprehensive review of the global TB burden and progress towards achieving these targets. The most recent edition, the “Global Tuberculosis Report 2024,” released in October 2024, presents data on the status of global TB as of 2023 and has also made this data available online [1,6]. This report discusses the status of the TB incidence and mortality in the world, the Organisation for Economic Co-operation and Development (OECD) member countries and the Republic of Korea (ROK) as of 2023.
Methods
To assess the global TB status, we used data from the “Global Tuberculosis Report 2024” [1]. Additionally, we analyzed country-specific TB data downloaded from the WHO website [6]. To analyze the rank of the OECD member countries, we extracted specific data on the TB incidence and mortality rates in these countries.
Results
In 2023, the global number of TB cases reached 10.8 million, equating to 134 cases per 100,000 population, a 0.9% increase from 2022 (10.7 million cases, 134 cases per 100,000 population) (Figure 1A) [1]. Adult men aged 15 and older accounted for 55% (6 million people), while adult women accounted for 33% (3.6 million people), and children under the age of 15 accounted for 12% (1.3 million people) [1]. An analysis of the global TB incidence rate rankings in 2023 revealed that the Marshall Islands (692 cases per 100,000 population), Lesotho (664 cases per 100,000 population), and the Philippines (643 cases per 100,000 population) occupied the top three positions respectively, with ROK, alongside Russia and Tunisia, ranked 111th with 38 cases per 100,000 population (Table 1) [1,6]. Regionally, the Southeast Asia region comprised 45% of global TB incidence, followed by the African region at 24%, and the Western Pacific region at 17%. The TB incidence rate in the Americas and the Western Pacific have increased for the third consecutive year. Conversely, TB incidence rates in the Eastern Mediterranean and Europe rose between 2020 and 2022 but slightly decreased in 2023. The TB incidence rate in the African region has shown a consistent decline since 2010. Notably, 87% of global TB incidence occurred in 30 high-burden countries, with eight countries including India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%), Pakistan (6.3%), Nigeria (4.6%), Bangladesh (3.5%), and the Democratic Republic of the Congo (3.1%) accounting for approximately 67% of these cases.
Figure 1. Global trends in the estimated (A) TB incidence rate and (B) TB mortality rate, 2010–2023.
HIV=human immunodeficiency virus; TB=tuberculosis. Reused from the World Health Organization [1].
Table 1. Global rankings of TB incidence and mortality rates by countries, 2023.
| Rank | Country | Incidence | Rank | Country | Mortality |
|---|---|---|---|---|---|
| 1 | Marshall Islands | 692 | 1 | Lesotho | 229 |
| 2 | Lesotho | 664 | 2 | Central African Republic | 142 |
| 3 | Philippines | 643 | 3 | Gabon | 139 |
| 4 | Myanmar | 558 | 4 | Guinea-Bissau | 122 |
| 5 | Central African Republic | 540 | 5 | Namibia | 98 |
| 6 | Kiribati | 533 | 6 | Myanmar | 90 |
| 7 | Democratic People’s Republic of Korea | 513 | 7 | South Africa | 88 |
| 8 | Gabon | 505 | 8 | Liberia | 85 |
| 9 | Timor-Leste | 498 | 9 | Congo | 84 |
| 10 | Mongolia | 491 | 10 | Eswatini | 77 |
| (...) | (...) | ||||
| 111 | Republic of Korea∙Russian Federation∙Tunisia | 38 | 110 | Republic of Korea∙Guatemala | 3 |
| Reference | Global | 134 | Reference | Global | 15.5 |
| The 30 high TB burden countriesa) | 189 | The 30 high TB burden countriesa) | 20 | ||
Values are presented as rate per 100,000 population per year. TB=tuberculosis. a)Angola, Bangladesh, Brazil, Central African Republic, China, Congo, Democratic People’s Republic of Korea, Democratic Republic of the Congo, Ethiopia, Gabon, India, Indonesia, Kenya, Lesotho, Liberia, Mongolia, Mozambique, Myanmar, Namibia, Nigeria, Pakistan, Papua New Guinea, Philippines, Sierra Leone, South Africa, Thailand, Uganda, United Republic of Tanzania, Viet Nam, Zambia. Reused from the World Health Organization [1,6].
Globally, the number of TB deaths in 2023 was 1.25 million, representing 15.5 deaths per 100,000 population, a 5.3% decrease from 2022 (1.32 million, 16.6 deaths per 100,000 population) (Figure 1B) [1]. Among these deaths, those among human immunodeficiency virus (HIV)-negative and HIV-positive people were estimated at 1.09 million (13 deaths per 100,000 population) and 161,000 (2.0 deaths per 100,000 population), respectively. Furthermore, adult men aged 15 years or older accounted for 52% of these deaths (n=568,000), adult women for 32% (n=352,000), and children under the age of 15 for 15% (n=166,000) [1]. In terms of global TB mortality rate rankings in 2023, Lesotho (229 deaths per 100,000 population), the Central African Republic (142 deaths per 100,000 population), and Gabon (139 deaths per 100,000 population) ranked 1st, 2nd, and 3rd, respectively, with the ROK and Guatemala both ranking 110th with 3 deaths per 100,000 population (Table 1) [1,6]. The African and Southeast Asia regions combined accounted for 81% of global TB deaths, and especially India account for 26% major of these deaths [1].
Within the 38 OECD member countries, the number of TB incidence were 157,000 in 2023, a 3.0% increase from 2022 (n=153,000), with the arithmetic mean TB incidence rate at 9.8 cases and the median at 5.9 cases per 100,000 population [6]. Among these countries, Colombia (46 cases per 100,000 population) had the highest TB incidence rate, followed by the ROK (38 cases per 100,000 population) and Mexico (29 cases per 100,000 population) (Figure 2A) [6]. Additionally, the number of TB deaths in OECD member countries was 16,668, marking a 6.7% decrease from 2022 (n=17,889), with the arithmetic mean TB mortality at 1.07 deaths per 100,000 population and the median at 0.55 [6]. Lithuania (4.6 deaths per 100,000 population) had the highest TB mortality rate, followed by Colombia (4.4 deaths per 100,000 population), Latvia (3.7 deaths per 100,000 population), Mexico (3.5 deaths per 100,000 population), and the ROK (3 deaths per 100,000 population) among OECD member countries (Figure 2B) [6].
Figure 2. Rankings of tuberculosis (A) incidence and (B) mortality rates among Organisation for Economic Co-operation and Development member 38 countries, 2023.
TB=tuberculosis. Data from the World Health Organization [6].
Globally, multidrug/rifampicin-resistant TB (MDR/RR-TB) cases in 2023 was 400,000, marking a 2.4% decrease from 2022 (n=410,000). The proportion of MDR/RR-TB cases among new TB case and previously treated cases was 3.2% and 16%, respectively [1].
The WHO estimated that the number of TB cases in the ROK remained the same at 20,000 in 2023, however, the TB incidence rate decreased by 5.0% from 2022 (40 cases per 100,000 population) to 38 cases per 100,000 population (Table 2) [6]. The incidence has continued to decline at an average of 7.2% per year since reaching its peak in 2011 (n=49,000). The number of TB deaths in 2023 was 1,500 (3 deaths per 100,000 population), a 6.3% decrease from 2022 (n=1,600) (Table 2) [6]. Additionally, the number of MDR/RR-TB cases was 790, down 6.0% from 2022 (n=840). Among new TB cases and previously treated cases, the proportion of MDR/RR-TB cases was 2.9% and 8.5%, respectively [6].
Table 2. Tuberculosis incidence and mortality rate and year-on-year increase and decrease rates in the Republic of Korea, 2013–2023.
| Year | Incidence | Mortality | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Case | Change ratea) | Rateb) | Change ratea) | Case | Change ratea) | Rateb) | Change ratea) | ||
| 2013 | 44,000 | –6.4 | 89 | –5.3 | 2,700 | –10.0 | 5.4 | –11.5 | |
| 2014 | 43,000 | –2.3 | 85 | –4.5 | 2,800 | 3.7 | 5.5 | 1.9 | |
| 2015 | 40,000 | –7.0 | 79 | –7.1 | 2,700 | –3.6 | 5.3 | –3.6 | |
| 2016 | 39,000 | –2.5 | 76 | –3.8 | 2,600 | –3.7 | 5.2 | –1.9 | |
| 2017 | 36,000 | –7.7 | 70 | –7.9 | 2,200 | –15.4 | 4.3 | –17.3 | |
| 2018 | 33,000 | –8.3 | 64 | –8.6 | 2,200 | - | 4.2 | –2.3 | |
| 2019 | 30,000 | –9.1 | 58 | –9.4 | 2,000 | –9.1 | 3.8 | –9.5 | |
| 2020 | 25,000 | –16.7 | 48 | –17.2 | 1,900 | –5.0 | 3.6 | –5.3 | |
| 2021 | 23,000 | –8.0 | 44 | –8.3 | 1,800 | –5.3 | 3.4 | –5.6 | |
| 2022 | 20,000 | –13.0 | 40 | –9.1 | 1,600 | –11.1 | 3.2 | –5.9 | |
| 2023 | 20,000 | - | 38 | –5.0 | 1,500 | –6.3 | 3 | –6.3 | |
Values are presented as number, a)change rate (%) compared with the previous year, and b)per 100,000 population. Reused from the World Health Organization [6].
The second milestone of the “WHO End TB strategy” targets a 50% reduction in TB incidence rate and a 75% reduction in the number of TB death by 2025 compared to 2015 levels. However, global progress has fallen short of these expectations, with only an 8.3% reduction in TB incidence rate and a 23.0% reduction in TB death from 2015 to 2023 (Table 3) [1,6]. The ROK has achieved this second milestone, reducing TB incidence rate by 51.9% in 2023 (38 cases per 100,000 population) compared to 2015 (79 cases per 100,000 population), and decreasing the number of TB deaths by 44.4% (Table 3) [1,6].
Table 3. The End TB strategy goals and progress toward the 2025 milestone in the world and the Republic of Korea.
| Indicator | End TB strategy goal | Percentage reduction in 2023 compared with 2015 | ||||||
|---|---|---|---|---|---|---|---|---|
| Milestone | Target | Global | Republic of Korea | |||||
| 2020 | 2025 | 2030 | 2035 | |||||
| Percentage reduction in the TB incidence rate | 20% | 50% | 80% | 90% | 8.3% (147 → 134 rate per 100,000 population) | 51.9% (79 → 38 cases per 100,000 population) | ||
| Percentage reduction in the number of TB deaths | 35% | 75% | 90% | 95% | 23.0% (1.63 million → 1.25 million) | 44.4% (2,700 → 1,500) | ||
Discussion
The global TB indicators for 2023 show a moderately positive trend, although the goal of “END TB by 2030” may be delayed due to the impact of the COVID-19 pandemic. While global TB incidence leveled off in 2023 after increasing since 2020, TB deaths continued to decline, mirroring the decrease observed in 2022. The WHO notes that the functionality of healthcare systems related to TB diagnosis and treatment is globally recovering following the COVID-19 pandemic [1]. However, it is anticipated that the second milestone of the “WHO End TB strategy,” which aims for a 50% reduction in TB incidence rate and a 75% reduction in the number of TB death by 2025 compared to 2015, will not be met. To still achieve the goal of ending the global TB epidemic by 2030, there needs to be an enhancement of universal health coverage for TB prevention, diagnosis, and treatment services, along with increased investment in TB response and research and development (R&D). This approach aligns with the political declaration adopted at the second high-level meeting on the fight against TB in September 2023 [5]. Specifically, it is crucial to develop innovative tools such as TB vaccines for adults by 2027. Moreover, multi-sectoral cooperation, including partnerships with local communities, civil society, international organizations, and countries, should be further strengthened.
The country-specific TB incidence statistics released by the WHO, which serve as the source for this article, are derived by adjusting for the number of unreported or undiagnosed TB cases and using mathematical modeling. This approach estimates the final number of TB cases in each country based on the reported data from national surveys or direct country submissions. In ROK, there is a slight discrepancy between the TB incidence statistics published by the WHO and those in the “Annual Report on the Notified Tuberculosis in the Republic of Korea in 2023” by the Korea Disease Control and Prevention Agency (KDCA). This variation arises because the WHO adjusts its estimates based solely on the undiagnosed cases among patients with TB. For TB mortality statistics, the WHO also employs mathematical modeling. This method estimates the final number of TB deaths in each country by adjusting for the weight of Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (International Classification of Diseases [ICD]-10 codes R00-R99), based on the number of deaths attributed to tuberculosis (ICD-10 codes A15-A19) and sequelae of tuberculosis (ICD-10 code B90). Given that ICD-10 codes R00-R99 account for more than 10% of the causes of death statistics in ROK, according to Statistics Korea, the WHO’s estimated number of TB deaths in ROK is relatively high. Consequently, there is a notable difference between the TB death statistics in ROK as published by the WHO and those reported by Statistics Korea. Therefore, when comparing and interpreting the TB statistics released by the WHO, KDCA, and Statistics Korea, it is important to consider the differences in the methodologies used by the WHO for adjustment and estimation and the TB incidence and mortality surveillance systems in ROK.
As ROK enters a super-aged society and the proportion of elderly individuals aged 65 or older among patients with TB increases annually, reducing the number of TB deaths presents a significant challenge [7,8]. Nevertheless, the KDCA is committed to implementing robust policies for TB prevention, early detection, and treatment management in the elderly population. These policies include a mobile TB screening project, encouragement of latent TB infection screening and treatment for contacts aged 65 or older, and a customized integrated management project for TB cases. Additionally, the KDCA has established and annually updates international cooperation initiatives as part of the “Third National Strategic Plan for TB Control in the Republic of Korea (2023-2027),” announced in March 2023. This plan aims to bolster ROK’s role in the global effort to end TB [9]. Since 2012, the KDCA has provided financial support through a memorandum of understanding on international contributions with the WHO Western Pacific Regional Office to eradicate TB in the WHO Western Pacific Region. In 2024, the KDCA also participates in the executive board meeting of global health organizations such as the World Health Assembly, Unitaid, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, engaging in high-level bilateral meetings to discuss global TB eradication and enhance international cooperation. Moreover, the KDCA participates in both domestic and international meeting, such as the Regional Prospective Observational Research in Tuberculosis International annual Meeting and the International Symposium on Seeking Ways to Eliminate TB in Asia. These platforms allow ROK to share its TB management and R&D achievements and facilitate information exchange with domestic and international TB researchers. The ROK is dedicated to the ongoing implementation of the “Third National Strategic Plan for TB Control in the Republic of Korea (2023-2027)” to achieve the goal of reducing the TB incidence rate to 20 or fewer cases per 100,000 population by 2027 and to contribute to the global eradication of TB.
Acknowledgments
None.
Declarations
Ethics Statement: Not applicable.
Funding Source: None.
Conflict of Interest: Young-Joon Park is an editorial board member of the journal, but was not involved in the review process of this manuscript. Otherwise, there is no conflicts of interest to declare.
Author Contributions: Conceptualization: HWL, JSK. Data curation: HWL, JSK. Formal analysis: HWL, JSK. Investigation: HWL, JSK. Methodology: HWL, JSK, JEK, YJP. Project administration: JEK, YJP. Supervision: JSK, JEK. YJP. Visualization: HWL, JSK. Writing – original draft: HWL, JSK. Writing – review & editing: HWL, JSK, JEK, YJP.
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