Gender and Tuberculosis: Global Gender Differences in Risk, Diagnosis, and Outcome
Scott Collier, Hiedi Haneefazi, Au’tiana Powell, Savannah Wagner
College of Southern Nevada Sociology-101
Professor Flora Rudacille
December 7, 2025
Gender and Tuberculosis: Global Gender Differences in Risk, Diagnosis, and Outcome
Tuberculosis (TB) continues to be one of the most significant infectious diseases worldwide, affecting populations across nearly every region and socioeconomic level. According to the World Health Organization’s most recent global report, an estimated 10.6 million people developed TB in 2022, demonstrating that the disease remains a persistent threat despite being both preventable and curable (World Health Organization, 2023). However, TB does not affect all people equally. In many countries, substantial gender disparities shape who gets diagnosed, how quickly they receive treatment, and what their long-term outcomes are. These disparities are influenced by a combination of biological susceptibility, social and cultural norms, and unequal access to healthcare. Partners In Health emphasizes that TB’s persistence is tied closely to structural inequities such as poverty, limited access to medical services, and gender-based barriers, which disproportionately harm women and marginalized communities (Partners In Health, n.d.). At the same time, evidence from Horton et al. (2016) shows that men have consistently higher rates of pulmonary, smear-positive TB in low- and middle-income countries, suggesting complex interactions between biological and social factors.
Understanding these disparities is essential for global development efforts because gender influences exposure, diagnosis, and treatment outcomes. Sustainable Development Goal (SDG) 5, which promotes gender equality, is directly tied to improving health under SDG 3 (Good Health and Well-being). By examining both biological mechanisms and social determinants, this paper highlights how gender shapes the global TB burden and why equality is central to disease control.
Tuberculosis remains widespread across all regions, but global surveillance shows clear and persistent gendered patterns. The World Health Organization (2023) reports that men account for the majority of TB cases globally, representing approximately 56 percent of all new infections, while women account for about one-third of global cases. Children comprise the remaining share (World Health Organization, 2023). This pattern has been observed for decades. Men develop and report more cases of pulmonary TB, while women are more likely to have cases that go undiagnosed, unreported, or delayed 3 due to barriers in accessing diagnostic services.
A major contributor to these disparities is the difference between infection risk and disease notification. Rickman et al. (2025), in a large population-based meta-analysis of immunoreactivity surveys, found that boys and girls have similar infection risk throughout childhood, and that infection risk remains nearly equal until adolescence. The disparity emerges after puberty, when adult men show significantly higher rates of confirmed infection, suggesting that hormonal and occupational factors contribute to increased susceptibility or exposure.
Evidence from low- and middle-income countries further supports the global pattern. Horton et al. (2016), in a systematic review across 56 surveys, found that men had significantly higher prevalence of smear-positive pulmonary TB, while women’s cases were disproportionately under-notified. Structural and social barriers, including stigma and restricted healthcare access, contribute to this underreporting. The Centers for Disease Control and Prevention (2025) also emphasizes that social determinants such as poverty, limited healthcare access, and crowded living conditions intersect with gender, increasing vulnerability for both men and women but in different ways.
Country-level analyses reveal additional gender dynamics. Marçôa et al. (2018) show that male TB notification rates sharply increase after age 20, with the highest incidence occurring among men aged 40–49. Women, by contrast, reach their highest rate in the 20–29 age range, less than half that of men in mid-adulthood. These findings reinforce that gender differences arise not only from biological susceptibility but from differential exposure shaped by social structures.
Biological factors play a significant role in shaping different outcomes of tuberculosis between men and women. Research consistently shows that men are more likely to develop smear-positive pulmonary TB, a pattern supported by findings from Rickman et al. (2025), who reported higher bacterial loads and more advanced disease at diagnosis in males. Hormonal and immune system differences contribute further to this disparity. According to Dabitao and Bishai (2023), sex hormones such as 4 testosterone and estrogen influence immune responses, with testosterone suppressing certain immune functions while estrogen enhances them. These biological factors become especially relevant after puberty, when hormonal changes intensify. Marçôa et al. (2018) also note that male biological susceptibility increases during adolescence and adulthood. This demonstrates that, although social and environmental factors are important, biological determinants play a critical role in the observed male-female gap in TB.
Social and cultural factors also shape gender disparities in tuberculosis diagnosis and treatment. For many women, stigma, family disapproval, and even social isolation may follow a TB diagnosis, as described by Carwile et al. (2025). Restrictive gender norms can prevent women from seeking timely care, especially in societies where women need permission before accessing health services, which reinforces structural inequalities and worsens health outcomes (Humayun et al., 2022). Men, on the other hand, may delay treatment due to work obligations or fear of appearing weak, according to Muttamba et al. (2024). These social challenges mean that both men and women may end up receiving care at more advanced stages of illness. This aligns with the Centers for Disease Control and Prevention (2025), which highlights social determinants as critical factors driving TB vulnerability.
When comparing TB across different economic and cultural settings, research shows that gender patterns do not always look the same everywhere. In Pakistan, women may appear to have more TB cases in certain regions; however, data is complicated by under-diagnosis and social barriers that prevent women from seeking medical attention (Khan et al., 2013). Similarly, studies in Uganda show that women may encounter cultural barriers that further reduce diagnosis rates and delay treatment because of gender norms that prevent them from seeking care independently (Muttamba et al., 2024).
Regarding socioeconomic factors, research in South Korea demonstrates that people experiencing poverty, crowded housing, and limited insurance coverage face delays in seeking care, which affects TB outcomes across genders (Choi et al., 2023). Conversely, in high-income countries, men still tend to have 5 higher TB rates despite greater access to healthcare, which may be linked to lifestyle factors such as smoking and alcohol use (Peer et al., 2023). These findings show that regional conditions, economic factors, and cultural contexts shape gender differences in TB, reinforcing that TB is not simply a biological disease but also a social one.
Gender equality plays a critical role in global TB control because gender-based barriers determine who gets treatment, who survives, and who is diagnosed. According to the World Health Organization (2023), TB continues to affect men and women worldwide, yet women often face additional obstacles including limited access to health facilities and delayed diagnosis. These findings align with the Centers for Disease Control and Prevention (2025), which highlights that health inconsistencies in TB are commonly driven by social differences, including gender.
SDG 5 promotes gender equality and supports the goals of SDG 3 by addressing unequal access to health and well-being. Evidence from Muttamba et al. (2024) shows that improving diagnosis strategies and increasing outreach can help reduce diagnostic delays, especially for women who encounter structural and cultural barriers. Partners In Health further emphasizes that community-based care and increased access to health services are essential for reducing TB mortality, particularly among underserved populations (Partners In Health, n.d.).
Gender differences in tuberculosis are shaped by a combination of biological risk and unequal access to healthcare resources. Horton et al. (2016) and Rickman et al. (2025) show how lack of access to basic health services and social barriers contribute to delayed diagnosis, higher transmission, and preventable deaths, especially among women. Aligning TB goals with SDG 5 strengthens the goals of SDG 3 because it prioritizes equitable disease prevention and treatment. As Partners In Health states, reducing TB requires addressing inequality rather than treating the disease alone. If gender-based 6 differences are addressed more effectively, health systems can make real progress in reducing tuberculosis on a global scale.
References
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