The study assesses global, regional, and national progress towards the 2020 milestones of the WHO End TB Strategy, focusing on tuberculosis incidence and mortality from 1990 to 2021. Key findings include: - **Global Burden**: In 2021, there were an estimated 9.4 million tuberculosis incident cases and 1.35 million deaths globally. The all-age tuberculosis incidence rate declined by 6.26% between 2015 and 2020, and the number of global tuberculosis deaths decreased by 11.9% during this period. - **Age-Specific Trends**: The incidence rate decreased by 16.5% in children under 5 years, 16.2% in those aged 5-14 years, 6.29% in those aged 15-49 years, 5.72% in those aged 50-69 years, and 8.48% in those aged 70 years and older. The mortality rate decreased by 11.9% globally, with a 35.3% reduction in deaths among children under 5 years and a 29.5% reduction in those aged 5-14 years. - **Progress Towards Milestones**: 15 countries achieved a 20% decrease in all-age tuberculosis incidence, and 17 countries achieved a 35% reduction in deaths. However, progress varied by age, with older adults (aged >50 years) showing the slowest decline. - **Risk Factor Impact**: Removing the combined effects of smoking, alcohol use, and diabetes would have reduced global tuberculosis deaths by 36.5% in 2020, with the largest benefits in older adults. - **COVID-19 Impact**: The pandemic's impact on tuberculosis mortality varied by country and age group. Some countries reported fewer deaths, while others reported more, with older adults contributing more to excess deaths in some countries. The study highlights the need for targeted interventions, especially for older adults, and emphasizes the importance of addressing risk factors to achieve the End TB targets.The study assesses global, regional, and national progress towards the 2020 milestones of the WHO End TB Strategy, focusing on tuberculosis incidence and mortality from 1990 to 2021. Key findings include: - **Global Burden**: In 2021, there were an estimated 9.4 million tuberculosis incident cases and 1.35 million deaths globally. The all-age tuberculosis incidence rate declined by 6.26% between 2015 and 2020, and the number of global tuberculosis deaths decreased by 11.9% during this period. - **Age-Specific Trends**: The incidence rate decreased by 16.5% in children under 5 years, 16.2% in those aged 5-14 years, 6.29% in those aged 15-49 years, 5.72% in those aged 50-69 years, and 8.48% in those aged 70 years and older. The mortality rate decreased by 11.9% globally, with a 35.3% reduction in deaths among children under 5 years and a 29.5% reduction in those aged 5-14 years. - **Progress Towards Milestones**: 15 countries achieved a 20% decrease in all-age tuberculosis incidence, and 17 countries achieved a 35% reduction in deaths. However, progress varied by age, with older adults (aged >50 years) showing the slowest decline. - **Risk Factor Impact**: Removing the combined effects of smoking, alcohol use, and diabetes would have reduced global tuberculosis deaths by 36.5% in 2020, with the largest benefits in older adults. - **COVID-19 Impact**: The pandemic's impact on tuberculosis mortality varied by country and age group. Some countries reported fewer deaths, while others reported more, with older adults contributing more to excess deaths in some countries. The study highlights the need for targeted interventions, especially for older adults, and emphasizes the importance of addressing risk factors to achieve the End TB targets.