Chapter 2 Epidemiology: the current burden of tuberculosis and its determinants Rita Verstraeten1,2, Marta Cossa2, Leonardo Martinez3, Kristin Nelson4, Dinis Nguenha2 and Alberto L. García-Basteiro1,2,5 1 ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain. 2 Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique. 3 Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA. 4 Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA. 5 Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain. Corresponding author: Alberto L. García-Basteiro (alberto.garcia-basteiro@isglobal.org) Cite as: Verstraeten R, Cossa M, Martinez L, et al. Epidemiology: the current burden of tuberculosis and its determinants. In: García-Basteiro AL, Öner Eyüboğlu F, Rangaka MX, eds. The Challenge of Tuberculosis in the 21st Century (ERS Monograph). Sheffield, European Respiratory Society, 2023 pp. 18–33 [https://doi.org/10.1183/ 2312508X.10023922]. @ERSpublications Global advances in reducing TB burden have been halted or reversed by the impact of the COVID-19 pandemic, with major effects on TB diagnosis and treatment. There is a need for renewed efforts to invert and accelerate the decline of TB figures. https://bit.ly/ERSM101 Copyright ©ERS 2023. Print ISBN: 978-1-84984-169-6. Online ISBN: 978-1-84984-170-2. Print ISSN: 2312-508X. Online ISSN: 2312-5098. Ending TB has been a global struggle for decades. Despite numerous efforts to accelerate the reduction in incidence and mortality, TB continues to be one of the top infectious killers worldwide. Global advances in reducing TB burden have been halted or reversed by the impact of the COVID-19 pandemic, with major effects on TB diagnosis and treatment. This chapter summarises evidence on the current burden of disease and on the different risk factors for TB, as well as their implications for past and current TB burden. There is an urgent need to strengthen our efforts and get back on track to achieve global TB targets, while taking into account risk factors and social determinants to help optimise intervention targets. Introduction With 10.6 million cases and 1.6 million deaths in 2021, TB is the 13th leading cause of death worldwide. Until the onset of the COVID-19 pandemic in 2019, TB was the leading cause of death due to a single infectious agent, Mycobacterium tuberculosis, and is again at the end 2022 [1, 2]. After more than a decade of decline, TB mortality increased in 2020 and 2021. Goals set by global organisations are increasingly seen as difficult to achieve in the wake of the COVID-19 pandemic. Burden of disease In 2014, the World Health Assembly approved the WHO’s End TB Strategy as part of the newly adopted sustainable development goals [3]. These goals included a reduction of 90% and 95% in TB incidence and TB deaths, respectively, by 2035, along with universal protection of households from facing catastrophic costs due to TB as of 2020 (table 1). By the end of 2021, 18 https://doi.org/10.1183/2312508X.10023922