Urban-Rural Disparities in Mortality due to Respiratory Tuberculosis in China: An Age-Period-Cohort Analysis from 1987 to 2021

Abstract Background China has a high disease burden of respiratory Tuberculosis (TB) and understanding the long-term trends in respiratory TB deaths and their epidemiological characteristics will assist China in achieving the WHO 2035 goal of ending the worldwide TB pandemic. To guide future respiratory TB preventive and intervention initiatives in China, this study thoroughly analyzed the secular trends of respiratory TB death statistics at a national level. Methods The annual estimate of respiratory TB mortality was derived from the National Health Commission (NHC). The trend pattern was detected using Joinpoint regression analysis, and the age-period-cohort model was used to estimate cohort and period effects. Results Between 1987 and 2021, China's respiratory TB mortality showed a consistent downward trend. respiratory TB mortality in urban areas decreased by 87% with an AAPC of -5.5% during the whole study period, while rural areas fell by 92% with an AAPC of -6.6%. There was a huge urban-rural disparity in respiratory TB mortality in China, with respiratory TB mortality in rural 2.05 times higher than that of the urban population in 1987, while by 2021 this figure had fallen to 1.32 times. respiratory TB mortality is higher in men than in women, and the relative risk gap has widened over time. Age effects in urban and rural areas presented inconsistent variation characteristics. The peak respiratory TB mortality rate occurs at 70–80 years of age in urban populations, whereas in rural with a peak occurs between 20 and 30 years. Overall, women had a higher mortality rate than men until the age of 25, but after 30 years, men's rates exceeded those of women. The period relative risk of respiratory TB mortality for urban and rural males and females showed a monotonic decreasing trend. And with the posterior shift of birth years, the cohort effect showed a decreasing trend. Conclusion There was a significant reduction in respiratory TB deaths between 1987–2021, particularly in rural areas. The risk of TB death is higher among men and rural populations. And the gap between urban and rural areas is widening, while the gender gap is closing. Certain groups such as children and older men need priority for prevention and control policies. The Chinese government should develop timely, effective, and targeted intervention strategies to further reduce respiratory TB mortality and help to achieve global respiratory TB control targets. Trial registration Not applicable.