Between 2015 and 2050, the number of people in the world aged 60 years or over is expected to double to 2.1 billion, of whom 80% will be living in low- and middle-income countries. This global increase in the older population masks gross life-course inequalities, both within and across countries, not only in life expectancy but also in the number of healthy life-years lost, including to disease and disability. In 2020, to reduce these inequalities and improve the health and well-being of older people, their families and communities, the United Nations General Assembly declared 2021–2030 the Decade of Healthy Aging.
Tuberculosis (TB) is an age-old disease typified by inequity that has been overlooked in such healthy aging strategies, despite a pronounced impact on older people. Although over recent decades, the human immunodeficiency virus (HIV) epidemic skewed TB notification rates toward younger people, especially in sub-Saharan Africa, the proportion of older people among all those newly diagnosed with TB globally is increasing and will likely continue to do so in line with life expectancy. Older people remain one of the largest reservoirs of TB infection worldwide. In low TB burden settings, this is predominantly due to distant exposure in early life whereas in high TB burden settings it may be more likely to relate to recent exposure. Most TB deaths and more than a quarter of TB-related disability adjusted life-years (DALYs) globally occur in people older than 50 years, with countries in the Southeast Asia and Western Pacific regions being particularly affected. In China, a country of 1.4 billion people, national TB prevalence surveys have demonstrated that older people, especially older men, have the highest prevalence of TB of all age groups.