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

Tuberculosis (TB) remains one of the most severe global public health challenges, imposing a heavy disease burden on the South-East Asia and Western Pacific regions. This study aims to assess the magnitude of absolute sex-related inequalities in TB incidence within these regions to provide empirical evidence for developing targeted public health policies. This study analyzed data from 36 countries and areas in the South-East Asia and Western Pacific regions, sourced from the WHO Health Equity Monitor database. The primary outcome indicator was the TB incidence rate per 100,000 population, stratified by sex. The absolute inequality measure, Difference (D = female incidence - male incidence), was employed to quantify the extent of sex-related inequality. In addition, D values were calculated separately for eight age groups (0–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, and ≥ 65 years) to assess whether the magnitude and direction of sex-related inequalities varied by age. Significant sex disparities in TB incidence were observed across both regions. Among the 36 included countries, 31 exhibited higher male incidence rates compared to females, with the Philippines (D=-513.5) demonstrating the most pronounced sex disparity. Conversely, in four countries, including the Nauru (D = 90.4), Palau (D = 47.4), Bhutan (D = 20.7), and Samoa (D = 1.9), female incidence rates surpassed those of males. Countries such as the Democratic People’s Republic of Korea and Myanmar simultaneously face the dual challenges of high overall incidence and sex imbalance. At the income level, the Democratic People’s Republic of Korea (D=-254.9), Philippines (D=-513.5), Mongolia (D=-424.0), and Nauru (D = 90.4) recorded the highest absolute disparities in the low-income, lower middle-income, upper middle-income and high income countries, respectively. Age-specific analysis showed that the direction and magnitude of D were not constant across age groups. Sex differences were generally small and heterogeneous in childhood and adolescence, whereas negative D values predominated from age 25 years onward. Significant and heterogeneous absolute sex-related inequalities in TB incidence exist in the South-East Asia and Western Pacific regions. There is an urgent need to integrate absolute sex inequality indicators into routine TB monitoring and evaluation frameworks. Future interventions should highly gender-sensitive, implementing specific strategies tailored to the population characteristics of different areas.