Background and aims: Tuberculosis (TB) remains a major global cause of death, particularly in developing countries. This study aims to identify key risk factors contributing to high TB incidence in these nations, analyze regional variations, and assess how risk factors differ across continents.

Methods: We conducted a retrospective analysis using data from 70 developing countries spanning 2000 to 2020, sourced from the World Bank Open Data. Variables included TB incidence, HIV prevalence, smoking rates, literacy rates, undernourishment, and population density. A random-effects model was employed to examine the associations between these factors and TB incidence.

Results: HIV prevalence (coefficient = 37.53, 95% CI: 34.28-40.79), smoking (3.51, 2.99-4.02), undernourishment (1.56, 1.02-2.10), and population density (0.16, 0.07-0.24) showed significant positive associations with TB incidence. Literacy rate was negatively associated with TB incidence (-0.11, -0.54 to 0.33), though not significantly. These findings highlight the strong influence of socio-demographic and health-related factors on TB burden.

Conclusion: TB continues to pose a serious health challenge in developing countries. HIV control, reduction of undernourishment and smoking, and managing population density are critical to reducing TB incidence. Regional differences underscore the need for tailored prevention strategies.