TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Pulmonary tuberculosis is common and has infected one-fourth of the population globally with peak incidence and mortality rates in the 1990s due to the HIV/AIDS epidemic, immigration, and the spread of multidrug-resistant TB (MDR TB). Few studies have reported pulmonary TB mortality trends. Our study reports and compares trends in pulmonary TB mortality between 1985 and 2018. METHODS: We utilized the World Health Organization (WHO) Mortality Database to extract Pulmonary TB mortality data based on the ICD 10 system. Based on the availability and quality of data region-wise, we included Canada and the USA from the Americas; Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Republic of Moldova, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, and United Kingdom from Europe; Australia, New Zealand, and Japan from Western Pacific region. Crude mortality rates were dichotomized by sex and reported by year. We computed Age Standardized Death Rates (ASDRs) per 100,000 population using the World Standard Population. Pulmonary Tuberculosis mortality trends were compared using Joinpoint regression analysis and reported using Estimated Annual Percentage Changes (EAPCs). RESULTS: Overall, in all 33 countries studied, we observed a decrease in mortality in both males and females except the Republic of Moldova, which showed an increase in females' mortality (0.12). Among all countries, Lithuania had the largest negative Percentage Change (PC) in male mortality (-12.01) between 1993-2018, and Hungary had the largest negative PC in female mortality (-1.57) between 1985-2017. Male mortality declined at a steady rate across the study period. Slovenia had the most rapid recent mortality decline for males with an EAPC of -47% (2003-2016), followed by Australia (-33.6%, 2014-2017), whereas Croatia and Austria showed an increase in EAPC of 25.0% (2015-2017) and, 17.8% (2010-2014) respectively. For females, New Zealand showed the most rapid recent mortality decline (-47.2%, 1985-2015), followed by Hungary (-35.1%, 2004-2007), whereas Croatia showed an increase in EAPC (24.9%, 2014-2017). CONCLUSIONS: Pulmonary TB mortality is disproportionately higher among Central and Eastern European countries. CLINICAL IMPLICATIONS: This contagious disease cannot be eliminated from any one region without a global approach. Priority action areas include ensuring early diagnosis and appropriate treatment to the most vulnerable groups. In low- and middle-income countries with high TB incidence, attenuation of socioeconomic determinants including extreme poverty, inadequate living conditions, and malnutrition remains crucial. DISCLOSURES: No relevant relationships by Chinmay Jani, source=Web Response No relevant relationships by Dominic Marshall, source=Web Response no disclosure on file for Omar Omari; No relevant relationships by Arashdeep Rupal, source=Web Response No relevant relationships by Justin Salciccioli, source=Web Response No relevant relationships by Joseph Shalhoub, source=Web Response No relevant relationships by Harpreet Singh, source=Web Response no disclosure on file for Carey Thomson; no disclosure on file for ALEXANDER WALKER