{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T05:16:07Z","timestamp":1783228567554,"version":"3.54.6"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key Research and Development Program of China","award":["2021YFC2302300"],"award-info":[{"award-number":["2021YFC2302300"]}]},{"name":"National Major Science and Technology Project for the Prevention and Control of Emerging and Major Infectious Diseases","award":["2025ZD01903600"],"award-info":[{"award-number":["2025ZD01903600"]}]},{"name":"Talent Project","award":["02-SWKJYCJJ21"],"award-info":[{"award-number":["02-SWKJYCJJ21"]}]},{"name":"Talent Project","award":["20230315"],"award-info":[{"award-number":["20230315"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Using Global Burden of Disease 2021 modeled estimates, we assessed the burden, temporal trends, and inequalities of pediatric all-form tuberculosis (TB) and multidrug-resistant TB (MDR-TB) from 1990 to 2021 across 204 countries and territories. Compared with all-form TB, pediatric MDR-TB showed a distinct and less favorable estimated trajectory. Although GBD-based estimates suggested overall declines in pediatric all-form TB incidence and mortality, the MDR-to-all-form ratio increased worldwide for both incidence and mortality, suggesting a growing proportional contribution of MDR-TB within the estimated pediatric TB burden. In 2021, pediatric MDR-TB remained concentrated in low- and low\u2013middle-SDI settings, where modeled socioeconomic inequalities appeared to become more pronounced over time. Mortality relative to incidence was highest among children aged under 5 years, with particularly elevated and imprecise mortality-to-incidence ratios for MDR-TB. Sex disparities also evolved differently by disease type: they generally narrowed for all-form TB but were more heterogeneous and in some settings widened for MDR-TB. These GBD-based findings suggest that progress in overall pediatric TB control may not have translated evenly to drug-resistant disease and highlight the need for pediatric TB strategies that explicitly address drug resistance, early childhood vulnerability, and inequitable access to diagnosis and treatment. Due to the sparsity of global pediatric data, no independent external validation was performed; findings are based on internal sensitivity analyses of GBD estimates.<\/jats:p>","DOI":"10.3390\/microorganisms14071467","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:39:11Z","timestamp":1783078751000},"page":"1467","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Divergent Trajectories of Pediatric All-Form Tuberculosis and Multidrug-Resistant Tuberculosis from 1990 to 2021"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5951-4538","authenticated-orcid":false,"given":"Qing","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine at the Seventh Medical Center, Chinese PLA General Hospital, Beijing 100700, China"},{"name":"College of Pulmonary and Critical Care Medicine at the Eighth Medical Center, Chinese PLA General Hospital, Beijing 100091, China"},{"name":"Department of Pulmonary and Critical Care Medicine, Medical School of Chinese People\u2019s Liberation Army, Beijing 100853, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine at the Seventh Medical Center, Chinese PLA General Hospital, Beijing 100700, China"},{"name":"College of Pulmonary and Critical Care Medicine at the Eighth Medical Center, Chinese PLA General Hospital, Beijing 100091, China"},{"name":"Department of Pulmonary and Critical Care Medicine, Medical School of Chinese People\u2019s Liberation Army, Beijing 100853, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025). 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