Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022. Of particular concern is the emergence of drug-resistant TB, accounting for 15%–20% of TB deaths. It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), drawing upon the comprehensive Global Burden of Disease (GBD) 2021 drug-resistant tuberculosis dataset.
From the GBD 2021, data on incidence, prevalence, disability-adjusted life years (DALYs), and death of MDR-TB and XDR-TB from 1990 to 2021 were collected. We calculated the estimated annual percentage changes in age standardized incidence rate (ASIR) and age-standardized death rate (ASDR), segmented by age, sex, and Socio-demographic Index (SDI). The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.
In 2021, there were an estimated 443,680 (95% uncertainty interval [UI]: 259,196–766,545) incident cases of MDR-TB, and an estimated 106,818 (95% UI: 41,612–211,854) death cases of MDR-TB, while there were an estimated 24,036 (95% UI: 17,144–34,587) incident cases of XDR-TB and 7,946 (95% UI: 3,326–14,859) death cases of XDR-TB. The incidence and death cases of MDR-TB were lowest in high SDI regions, whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.
This study reported the disease burden of drug-resistant TB from 1990 to 2021. Until 2021, drug-resistant TB is still a serious problem in low SDI countries, especially for high-risk age populations with high-risk factors. Controlling drug-resistant TB requires effective control strategies and healthcare systems.
Perchlorate and chlorate are ubiquitous pollutants that can adversely affect the thyroid function in humans. This study assessed the potential health risks associated with the dietary exposure of infants and young children to perchlorate and chlorate present in infant formulas available in Shanghai. The assessment was based on risk monitoring data from 150 samples of infant formulas in Shanghai between 2020 and 2022, along with the dietary consumption data of infants and young children. The detection rates of perchlorate and chlorate in infant formulas were 46.0% and 98.7%, with mean contents of 9.98 μg/kg and 112.01 μg/kg, and the maximum values of 151.00 μg/kg and 1475.00 μg/kg, respectively. The mean and 95th percentile (P95) values of daily perchlorate exposure of 0–36-month-old infant and young children via infant formulas were 0.07 and 0.17 μg/kg body weight (bw) per day, respectively, which were lower than the tolerable daily intake (TDI) of perchlorate (0.3 μg/kg bw per day). The mean and P95 values of chlorate exposure via infant formulas in 0–36-month-old infants and young children were 0.83 and 1.89 μg/kg bw per day, which were lower than the TDI of chlorate (3 μg/kg bw per day). The P95 exposure of different age groups (0–6 months, 7–12 months and 13–36 months) of infants and young children to perchlorate and chlorate in infant formulas was below the TDI. Therefore, the risk associated with the exposure of 0–36-month-old infants and young children to perchlorate and chlorate from infant formulas in Shanghai is considered acceptable. Prioritizing environmental pollution control efforts to reduce the levels of perchlorate and chlorate in food products is important to safeguard the health of the infants and children under the One Health concept.