We conducted a cohort study to compare the characteristics
of MDR-TB with non-MDR-TB patients and to measure long term (9-year) mortality
rate and determine factors associated with death in China.
We reviewed the medical records of 250 TB cases from a 2001
survey to compare 100 MDR-TB patients with 150 non-MDR-TB patients who were
treated in 2001-2002. Baseline attributes extracted from the records were
compared between the two cohorts and long-term mortality and risk factors were
determined at nine-year follow-up in 2010.
Among the 234 patients successfully followed up, 63 (26.9%)
were female and 171 (73.1 %) were male. MDR-TB patients had poorer
socioeconomic status compared to non-MDRTB. Nine years after the diagnosis of
TB, 69 or 29.5 % of the 234 patients had died (32 or 21.6 % of non-MDR-TBversus 37 or 43.0 % of MDR-TB) and the overall
mortality rate was 39/1000 per year (PY) (27/1000 PY among non-MDR versus 63/1000 PY among MDR-TB). Factors associated with
death included: MDR status (hazard ratio (HR): 1.86; CI: 1.09-3.13), limited
education of primary school or lower (HR: 2.51; CI 1.34-4.70) and received TB
treatment during the nine-year period (HR 1.82; 95 % CI 1.02-3.26).
MDR-TB was a strong predictor for poor long-term outcome.
High quality diagnosis and treatment must be ensured. Greater reimbursement or
free treatment may be needed to provide access for the poor and vulnerable
populations, and to increase treatment compliance.
Below: Geographical location of counties surveyed in Henan Province, 2001 and 2010
Below: Survival analysis estimates of long-term survival based on drug resistance status
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