Abstract: Objective To analyze the dynamic trends in the disease burden of tuberculosis in China between 1990 and 2021, explore the influence of key risk factors on this burden, and forecast future trajectories. Methods Data pertaining to the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of tuberculosis in China, along with their corresponding age-standardized rates (ASR), were sourced from the Global Burden of Disease (GBD) 2021 database. The Joinpoint regression model was utilized to analyze temporal trends, calculating the annual percent change (APC) and the average annual percent change (AAPC). Future trends in the tuberculosis burden from 2022 to 2035 were projected using the Norpred model. Results a significant decline was observed in the age-standardized incidence rate (ASIR) of tuberculosis in China, which decreased from 109.01 per 100 000 population in 1990 to 36.28 per 100 000 in 2021 (AAPC=-3.48%, 95% CI: -3.63% to -3.34%). Similarly, the age-standardized prevalence rate (ASPR) demonstrated a reduction from 31,445.76 per 100 000 to 30,557.45 per 100 000 (AAPC=-0.10%, 95% CI: -0.14% to -0.06%), while the age-standardized mortality rate (ASMR) experienced a substantial drop from 20.09 per 100 000 to 1.91 per 100 000 (AAPC=-7.42%, 95% CI: -7.78% to -7.07%). The age-standardized DALY rate (ASDR) also saw a considerable decrease from 719.42 per 100 000 to 76.22 per 100 000 (AAPC=-7.00%, 95% CI: -7.18% to -6.81%). The disease burden was found to be greater in males than in females. The primary attributable risk factors were identified as smoking and alcohol consumption, which were associated with 28.0% and 18.4% of mortality risk, and 28.0% and 18.8% of DALYs, respectively. Projections from the Norpred model suggest that the downward trends in ASIR, ASMR, and ASDR are expected to continue from 2022 to 2035. Conclusion China has achieved a notable reduction in the burden of tuberculosis. However, a higher burden persists in the male population, and smoking and alcohol consumption remain the principal modifiable risk factors. To further mitigate the disease burden of tuberculosis, it is imperative to refine prevention and control strategies and implement more targeted interventions for high

Key words: Tuberculosis, Disease burden, Trend analysis, Risk factors, Trend prediction