WHO regional data reveal sex-based tuberculosis gaps in 36 settings

An observational analysis of World Health Organization data found substantial and highly variable sex-based inequalities in tuberculosis incidence across 36 countries and areas in the WHO South-East Asia and Western Pacific regions. Male incidence rates were higher in 31 settings, while female rates were higher in Nauru, Palau, Bhutan and Samoa. The largest reported difference was in the Philippines, where female incidence minus male incidence was −513.5 per 100,000 population. Nauru recorded the largest difference in the opposite direction, at 90.4 per 100,000. The results show that the direction and magnitude of tuberculosis inequality differed markedly across countries and age groups.

The study used records from the WHO Health Equity Monitor database and examined tuberculosis incidence rates per 100,000 population, stratified by sex. Its primary measure was the absolute incidence difference, defined as D = female incidence rate − male incidence rate. A negative D therefore means that the male rate was higher, while a positive D means that the female rate was higher. This measure retains the scale of the disparity in rate units rather than expressing it as a relative ratio. The analysis covered both WHO South-East Asia and Western Pacific regions, and its age-specific calculations separated the data into eight groups: ages 0–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64 and 65 or older.

Country-level results demonstrated that a male-higher pattern was widespread but not universal. In addition to the Philippines, where D was −513.5 per 100,000, Mongolia had a difference of −424.0 and the Democratic People’s Republic of Korea had a difference of −254.9. The study also identified Myanmar and the Democratic People’s Republic of Korea as places facing both high overall tuberculosis incidence and a marked sex imbalance. These two conditions describe different aspects of the burden: the first concerns the overall incidence level, while the second concerns the absolute gap between female and male rates. The analysis did not determine the causes of either pattern.

The four settings with higher female incidence each had a different size of difference. Nauru recorded D = 90.4 per 100,000, Palau 47.4, Bhutan 20.7 and Samoa 1.9. These results counter a uniform interpretation in which male incidence is always higher. The country-level pattern also varied when places were grouped by national income. The largest absolute sex gap was reported in the Democratic People’s Republic of Korea among low-income countries, in the Philippines among lower-middle-income countries, in Mongolia among upper-middle-income countries and in Nauru among high-income countries. The analysis therefore did not reveal a single direction or magnitude of sex inequality across all income categories.

Age-stratified results showed further variation. The direction and magnitude of D were not constant across the eight age groups. Sex differences were generally small and heterogeneous during childhood and adolescence, whereas negative D values predominated from age 25 onward. In those older age groups, the more frequent negative values indicate higher male than female incidence rates, but the analysis does not imply that every individual age group or country followed the same pattern. The study concludes that absolute sex-inequality indicators should be incorporated into routine tuberculosis monitoring and evaluation. Its findings also support gender-sensitive interventions tailored to the population characteristics of different areas. As a country-level observational analysis of incidence-rate differences, the research cannot identify the mechanisms responsible for the observed inequalities, describe how they are distributed within individual populations or determine whether a particular intervention would reduce them.

Subject of Research: Absolute sex-based inequalities in tuberculosis incidence across 36 countries and areas in the WHO South-East Asia and Western Pacific regions

Article Title: Mapping sex-based absolute inequalities in tuberculosis incidence across countries in the WHO South-East Asia and Western Pacific regions

Article References: Li, Z., Liu, K., Shu, W., Sun, Y., Li, Z., Zhang, L., Du, J., Liu, Y., Li, L., & Fu, L. (2026). Mapping sex-based absolute inequalities in tuberculosis incidence across countries in the WHO South-East Asia and Western Pacific regions. BMC Public Health. https://doi.org/10.1186/s12889-026-29724-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29724-9

Keywords: tuberculosis incidence, sex inequality, health equity, WHO Health Equity Monitor, South-East Asia, Western Pacific, age stratification, public health monitoring, epidemiology, absolute difference, Mapping, sex-based