To explore the trends in the burden of multidrug-resistant tuberculosis (MDR-TB) in China and its associated risk factors based on the Global Burden of Disease database (GBD).

Data on the incidence, mortality, and disability-adjusted life years (DALYs) related to MDR-TB in China from 1990 to 2021 were extracted from the GBD 2021 database. The trends in disease burden and risk factors were assessed using the rate of change and annual estimated percentage change.

From 1990 to 2021, the age-standardized incidence rate (ASIR) of MDR-TB in China decreased from 3.4 504(95%UI: 0.9 415 to 9.4 455) per 100 000 to 1.4 932 (95%UI: 0.2 544 to 4.6 586) per 100 000, with an estimated annual percentage change (EAPC) of -6.6 (95%CI: -7.8 to -5.38). The age-standardized DALY rate (ASDR) fell from 40.455 (95%UI:9.522 to 116.1805) per 100 000 to 5.1077 (95%UI: 0.8967 to 15.0293) per 100 000, with an EAPC of -10.07 (95%CI: -11.24 to -8.89). The age-standardized mortality rate (ASMR) decreased from 1.176 (95%UI: 0.2691 to 3.4253) per 100 000 to 0.1469(95%UI: 0.0246 to 0.4272) per 100 000, with an EAPC of -10.03 (95%CI: -11.23 to -8.82). During the same period, the number of new cases decreased by 30.07%, the number of DALYs decreased by 77.44%, and the number of deaths decreased by 71.3%. Additionally, significant age and gender disparities were observed in the burden of MDR-TB in China. From 1990 to 2021, the declines in age-standardized incidence, DALY rates, and mortality rates were more pronounced in females than in males. Furthermore, smoking, alcohol consumption, high fasting blood glucose, and high body mass index were significant contributors to DALYs and mortality related to MDR-TB, with their contributions increasing over time.

There has been a significant downward trend in the burden of MDR-TB in China from 1990 to 2021. Attention should be given to the trends in MDR-TB burden among individuals aged 60 and above and males. Tailored prevention and control policies and measures should be developed based on the characteristics of different age groups and genders, along with the primary risk factors, to effectively reduce the overall disease burden of MDR-TB in China.