| Objective:1.This study aimed to analyze the drug-resistant tuberculosis(DR-TB)cases registered in the Tuberculosis Information Management System in Shanxi Province from 2012 to 2020,and to understand the epidemic characteristics and spatial distribution of DR-TB by combining with the county(city,district)map,to provide atheoretical basis for the scientific development of epidemic prevention and control measures.2.This study aimed to clarified the catastrophic cost proportion in DR-TB family by investigating the direct and indirect economic burden of DR-TB patients and their family in the treatment during Shanxi Province,so as to provide the basic data and reference for DRTB patient economic burden policy in Shanxi Province.Methods:1.Epidemic analysis.The information of drug-resistant TB cases registered during 2012-2020 was derived from the Tuberculosis Information Management System,a subsystem of China Disease Control and Prevention Information System.Descriptive epidemiological methods were used to analyze the population,time and regional distribution characteristics of DR-TB in Shanxi Province.The global spatial autocorrelation and local spatial autocorrelation of drug-resistant tuberculosis in Shanxi Province were analyzed by using spatial epidemiological methods.SPSS26.0 software was used for descriptive statistical analysis.The population,time and regional distribution characteristics are described by the adoption rate or composition ratio,and the change trend of drug resistant tuberculosis registration rate in different years is described by the linear χ2 test.Use ArcGis 10.8 and GeoDa 1.20 software to conduct global and local spatial autocorrelation analysis.2.Economic burden analysis.Based on the Questionnaire on Family Economic Burden of tuberculosis Patients issued by China Center for Disease Control and Prevention,and in combination with the current epidemiology of DR-TB in Shanxi Province,the Questionnaire on Family Economic Burden of Drug resistant tuberculosis Patients was formed.By means of face-to-face inquiry or telephone interview,we investigated the drug resistant patients in 10 designated hospitals in Shanxi Province who were confirmed by drug sensitivity test.The general demographic characteristics,diagnosis and treatment of patients,direct medical expenses,direct non-medical expenses and indirect expenses during treatment,and coping after illness were investigated.The diagnosis and treatment of patients were queried by investigators through the electronic medical record system and transcribed in the questionnaire.Qualitative data such as demographic characteristics were described by frequency and component ratio,while quantitative data such as patient costs were described by median and quartile interval.Rank sum test was used to compare the quantitative data with non-normal distribution,and multiple linear regression model was used to analyze the influencing factors of patients’ total economic burden.Results:1.Prevalence of DR-TB in Shanxi Province(1)From 2012 to 2020,the reported incidence rate of pulmonary tuberculosis in Shanxi Province decreased from 59.21/100000 in 2012 to 27.50/100000 in 2020,showing a downward trend year by year(trend χ2=6063.578,P<0.001).The drug resistance screening coverage increased from 6 counties in 2012 to 106 counties in 2020,and the drug resistance screening rate increased from 2.37%in 2012 to 72.29%,showing an upward trend year by year(trend χ2=14780.96,P<0.001).(2)From 2012 to 2020,there were 1075 DR-TB patients reported in Shanxi Province,including 758 male patients and 317 female patients,the sex ratio of DR-TB patients was 2.39:1.The age is mainly 40～59 years old,accounting for 38.51%of all patients.The occupation is mainly farmers,accounting for 57.02%of all patients.Reported cases of DRTB rose first in nine years and then declined,from 0.03/100000 in 2012 to 0.70/100000 in 2019 and 0.46/100000 in 2020.The annual reported incidence was 0.33/100 000.The counties(cities,districts)with high reported incidence were mainly concentrated in Linfen,Changzhi and Yuncheng.(3)The results of spatial autocorrelation analysis showed that there was an overall spatial autocorrelation in the registration rate of drug-resistant TB in Shanxi Province from 2017 to 2019,Moran’s I index was 0.341,0.134 and 0.280,respectively,and the difference was statistically significant.Local spatial autocorrelation results showed that from 2012 to 2016,the "high-high" cluster of drug-resistant tuberculosis was mainly concentrated in some counties(cities,districts)of Taiyuan,Luliang and other cities.From 2016 to 2020,the "highhigh" gathering areas are mainly distributed in some counties(cities,districts)of Changzhi,Yuncheng,Jincheng,Datong and other cities.2.Economic burden analysis.(1)Demographic characteristics.A total of 112 patients with drug-resistant tuberculosis were included in this study,most of them were male patients(76,67.86%),patients aged 3059 years(61,54.46%),patients who took second-line individualized treatment(90,80.36%),patients who were hospitalized for less than 2 months(59,52.68%),and patients who participated in medical insurance for urban and rural residents(99,88.39%).The median annual family income of the patients was 6(48)thousand Yuan;53 patients(47.32%)had an annual family income of less than 60,000 yuan;59 patients(52.68%)had an annual family income of more than 60,000 yuan.(2)Diagnosis and treatment.The drug-resistant patients were mainly those who were initially treated(72 cases,64.29%),multidrug-resistant(88 cases,78.57%),planned treatment duration of 24 months(81 cases,68.64%),accumulated hospitalization duration of 2 months(40cases,33.90%),and participated in the new rural cooperative medical insurance(47 cases,39.83%).(3)Economic burden and influencing factors.In the whole course of treatment,the total family burden of patients was 118953.54 yuan,with a median of 108210.16 yuan(52854.56165820.99).The average direct medical economic burden was 79052.86 yuan,with a median of 70418.90 yuan(30793.75,116519.51),accounting for 66.46%of the total economic burden;The direct non-medical economic burden of all cases was 22036.20 yuan,with a median of 20872.42 yuan(9715.9829177.87),accounting for 18.52%of the total economic burden;The average indirect economic burden was 17864.48 yuan,with a median of 9176.50 yuan(5213.4818249.83),accounting for 15.02%of the total economic burden.Chi-square analysis showed that gender,occupation,marital status,registration classification,and length of stay were the factors of high total financial burden(P<0.05).Multiple linear regression analysis showed that the length of hospitalization,gender and occupation were the influencing factors of the total economic burden of the patient’s family.(4)Occurrence of catastrophic total costs and patients’ response after illness.Among the 112 patients,98 patients suffered from catastrophic total costs and the incidence of catastrophic total costs was 87.50%.The occupation of 26(23.21%)patients changed after illness,21(87.77%)of whom were unemployed due to illness.After the disease,83(74.11%)of the patients’ annual personal income was lower than the provincial average level in 2019,and 62(52.54%)of the patients’ annual family income decreased.86(76.79%)of the patients believed that the illness affected their personal or social life,of which 28.95%patients felt that the disease affected food and clothing.50(44.64%)patients were in debt due to disease treatment,with an average loan of 83340 yuan.Conclusion:1.From 2012 to 2020,the registration rate of DR-TB in Shanxi Province showed an upward trend.We should strengthen the prevention and treatment of DR-TB among highrisk groups such as men,middle-aged and farmers.2.The reported number and reported incidence of DR-TB in 2020 were much lower than in 2019.We should formulate relevant countermeasures according to the causes,learn from relevant experience,and prevent such incidents from happening again.3.Spatial aggregation analysis showed that high concentrations of DR-TB occurred in some counties(cities and districts)of Changzhi City,Jincheng City,Yuncheng City,Taiyuan City,Datong City and Lvliang City.These areas should be taken as key prevention and control areas to prevent the further spread of drug resistance.4.The economic burden of DR-TB patients is heavy,and the direct medical burden is the main factor leading to the heavy economic burden.The current medical security measures have little effect on reducing the burden of patients’ families.Male,hospital stay longer than 2 months,and patient occupation were risk factors for high economic burden of patients.5.The incidence of catastrophic expenditures among families of DR-TB patients is high.We should take targeted measures to reduce the incidence of catastrophic family pointing. |
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