Abstract
Tuberculosis (TB) remains a major public health burden in Vietnam, yet few studies have examined pulmonary TB mortality trends at sub-national levels, where local epidemiological patterns may differ substantially from national averages and reveal high-risk populations requiring targeted interventions and inform resource allocation. Lang Son, Vietnam, is a mountainous border province with many ethnic minority residents, and extensive cross-border movement creates distinct challenges for TB surveillance and treatment adherence. Although mortality has declined in line with national trends, rates in this border province remain higher than those in Vietnam's major urban centers. This disparity suggests a hidden burden where Lang Son's unique geographic challenges and ethnic diversity create health inequities that are often obscured by favorable national-level averages. To better understand local epidemiological patterns, this study examined temporal trends and gender differences in pulmonary TB mortality in Lang Son Province over a 12-year period (2005-2008 and 2011-2018). Using data from a population-based mortality registration system, we calculated crude and age-standardized mortality rates (ASR) per 100,000 person-years. Temporal trends were assessed using Poisson regression. The overall ASR was 7.7 per 100,000 person-years among men (95% CI: 6.5-9.0) and 1.9 among women (95% CI: 1.3-2.7), yielding a male-to-female ASR ratio of 4.1. The age-standardized pulmonary TB mortality declined by approximately 49.2% (from 6.3 (95% CI: 4.1-9.2) to 3.2 (95% CI: 1.9-4.9) per 100,000 person-years; p = 0.025). Notably, 69.9% of deaths occurred in individuals under age 70. While declines were observed in both sexes, sex-specific temporal trends were not statistically significant (p > 0.05). Despite these improvements, persistently higher mortality among men and older adults highlights ongoing inequities in TB outcomes within the province. These pre-pandemic findings provide an essential epidemiological baseline for assessing COVID-19's impact on TB control and underscore the need for age- and gender-targeted interventions at sub-national levels to accelerate Vietnam's progress toward TB elimination.