pandemic laid bare the wide and existing inequities in global health. High-income countries raised funds for COVID-19 diagnostics, treatment and vaccination at an unprecedented speed. While this benefited those countries and significantly slowed the global pandemic, many of these tools still remain inaccessible to low-resource countries [41, 43]. Modelled projections provided by the WHO show a further increase in TB incidence and mortality in future years, emphasising the importance of redoubling our commitment in the fight against TB [1]. Inidividual and socioeconomic determinants of TB Bringing an end to TB relies on effective prevention and treatment. This requires early detection, which in turn depends on the identification and screening of TB-exposed individuals. Together, these underscore the importance of quality diagnostic methods and treatment strategies [44]. However, this will not be enough to end the TB epidemic. Rates of TB infection and development can also be reduced by addressing the determinants of TB. These include individual health-related risk factors (such as HIV, diabetes and smoking) and broader socioeconomic determinants (such as poverty, working and living conditions, and lack of food security) [45]. Evidence of the role of socioeconomic risk factors in TB epidemiology continues to grow [46–50], with an impact on all stages, from risk of exposure to clinical outcome [51]. According to the latest estimates from the WHO, a high proportion of new TB cases can be attributed to five risk factors: undernourishment, HIV infection, alcohol-use disorders, smoking and diabetes (figure 3). The two largest contributors to new TB cases, undernourishment and HIV infection, show geographical overlap in the sub-Saharan African region (figure 4), resulting in a large burden of all three conditions [52]. The socioeconomic drivers of this burden include poverty, hunger, unemployment and homelessness [52]. Socioeconomic determinants Socioeconomic determinants of health as defined by the WHO are non-medical factors that influence health outcomes [53]. For TB, the upstream socioeconomic determinants driving TB burden are elevated levels of migration, fast urbanisation and population increases. These determinants in turn lead to downstream inequalities, such as food security and undernutrition, poor housing conditions, and barriers to medical care (including insufficient funds, length of distance to facilities, and cultural restrictions) [51, 53]. The living environment affects exposure risk to TB. For instance, poor ventilation, overcrowding, and homelessness or housing instability increase the likelihood of exposure to M. tuberculosis and therefore increase the risk of TB Alcohol-use disorders HIV infection Undernourishment Smoking Diabetes 0.5 1.0 1.5 2.0 Attributable cases (millions) FIGURE 3 Estimated TB incidence attributable to the top five risk factors in 2021. Data points represent estimated attributed cases bars represent 95% confidence intervals. Reproduced and modified from [44] with permission. https://doi.org/10.1183/2312508X.10023922 25 EPIDEMIOLOGY |R. VERSTRAETEN ET AL.