Ecologic Study On The Drug-resistance Characteristic Of Primary Treated Tuberculosis In The Global

Tuberculosis is a severe chronic disease which is infected by Mycobacterium tuberculosis. Primary treated tuberculosis refers to the kind of tuberculosis that never be treated with anti-TB drugs or less than 1 month. The definition of Drug-resistant TB is that Mycobacterium tuberculosis collected from the TB patients could growth in a Petri dish with one or more anti-TB drugs in vitro. Drug-resistant TB is less sensitive to ordinary treatment, meanwhile, could cause chronic infectiousness and large economic consumption. In 2007, the worldwide patients of Drug-resistant TB are estimated at 500,000, among which 85% of the patients are distributed in'27 countries with Drug-resistant TB high-burden', Till the end of 2009, there are 57 countries and districts reporting widespread of Drug-resistant TB. Among patients of Primary treated tuberculosis, multiple drug resistant rate is 2.9%, the total resistance rate is 17.0%.Drug-resistant Tuberculosis has already been around the world, threatens the implementation of the Global DOTS and TB control.Less patient compliance and worse public health supervision are widely considered as the main reasons for TB resistance. Even though the emergency of resistant strains is the same results of human, biological arid environmental factors, conclusions of researches greatly vary due to different survey groups or subjects. In order to explore influential factors associated with drug-resistant tuberculosis and patterns of global drug-resistance, this study applies ecological research methods together with exploratory and confirmatory factor analysis to respectively extract latent factors from climate geography variables, tuberculosis-related variables and primary treated drug-resistant variables based on the 4th global TB monitoring report. The Structure Equation Model (SEM) based on latent factors above-mentioned was further respectively formulated to explain the direct and indirect relationship between climate geography factors and tuberculosis related factors and primary treated drug-resistant tuberculosis.Research results are as follows:1. There are 2 latent factors extracted from the geography climatic variable, named as temperature factor and humidity factor respectively. The temperature factor dominates annual atmospheric temperature (standardized factor loading value 0.96), temperature climate (standardized factor loading value 0.93) and geography latitude (standardized factor loading value 0.92). The humidity factor dominates geography climatic zone (standardized factor loading value 0.84) and annual precipitation (standardized factor loading value 0.81).2. We extracted 4 latent factors from the TB (Tuberculosis) related variables, named them as TB epidemic factor, health service quality factor, medical expenses factor and the implementation of DOTS factor respectively. The TB epidemic factor dominates case notification rates (standardized factor loading value 0.61), incidence Smear-positive* rate (standardized factor loading value 0.85), prevalence All forms* rate (standardized factor loading value 0.89), TB mortality All forms* rate (standardized factor loading value 0.92), prevalence of tuberculosis (per 100 000 population) (standardized factor loading value 0.97) and Deaths due to tuberculosis among HIV-negative people (per 100 000 population) (standardized factor loading value 0.97). The health service quality factor dominates under-5 mortality rate (probability of dying by age 5 per 1000 live births) both sexes (standardized factor loading value 0.49), population with sustainable access to improved sanitation (%) rural (standardized factor loading value -0.85), one-year-olds immunized with three doses of diphtheria tetanus toxoid and pertussis (DTP3) (%) (standardized factor loading value -0.73), one-year-olds immunized with MCV (%) (standardized factor loading value -0.72), infant mortality rate (per 1 000 live births) both sexes (standardized factor loading value 0.96) and Adult mortality rate (probability of dying between 15 to 60 years per 1000 population) both sexes (standardized factor loading value 0.89). The medical expenses factor dominates total expenditure on health as percentage of gross domestic product (standardized factor loading value 0.76), per capita government expenditure on health at average exchange rate (US$) (standardized factor loading value 0.77) and out-of-pocket expenditure as percentage of private expenditure on health (standardized factor loading value -0.30). The implementation of DOTS factor dominates DOTS new smear-positive treatment success (%) (standardized factor loading value 0.89) and Tuberculosis treatment success under DOTS (%) (standardized factor loading value 0.99).3. The results of multivariate stepwise linear regression show that, annual atmospheric temperature, deaths due to tuberculosis among HIV-negative people (per 100 000 population) and out-of-pocket expenditure as percentage of private expenditure on health have positive relationship with transformational total drug-resistant rate and multiple drug-resistant total rate. Per capita government expenditure on health at average exchange rate (US$) and geography climatic zone have negative relationship with transformational multiple drug-resistant total rate.4.4 latent factors extracted from the global TB initial treatment drug-resistant rate, named as HS-resistant factor, R-resistant factor, RE-resistant factor and E-resistant factor. Therein, the HS-resistant factor dominates drug-resistant group HS (standardized factor loading value 0.86), HRES (standardized factor loading value 0.76), HRS (standardized factor loading value 0.69), HES (standardized factor loading value 0.66) and S (standardized factor loading value 0.53). The R-resistant factor dominates drug-resistant group R (standardized factor loading value 0.96), RS (standardized factor loading value 0.79) and HR (factor loading value 0.25). The RE-resistant factor dominates drug-resistant group RES (standardized factor loading value 0.60), ES (standardized factor loading value 0.51) and RE (standardized factor loading value 0.62). The E-resistant factor dominates drug-resistant group HRE (factor loading value 0.56), HE (standardized factor loading value 0.77) and E (standardized factor loading value 0.61).5. The total effect of temperature factor on HS-resistant factor is 0.14. The total effect of humidity factor on HS-resistant factor, R-resistant factor, RE-resistant factor and E-resistant factor is -0.53,-0.22,-0.37 and -0.15 separately. The temperature factor has less indirect effect on drug-resistant factor. The indirect effect of humidity factor on R-resistant factor, RE-resistant factor and E-resistant factor is -0.11,-0.10 and-0.15 respectively.6. The total effect of TB epidemic factor on HS-resistant factor and E-resistant factor is 0.23 and 0.27 separately. The total effect of health service quality factor on R-resistant factor is-0.21. The total effect of medical expenses factor on HS-resistant factor, R-resistant factor, RE-resistant factor and E-resistant factor is -0.11,-0.29,-0.20 and -0.10 separately. The total effect of the implementation of DOTS factor on E-resistant factor is 0.25. The indirect effect of medical expenses factor on E-resistant factor is-0.10.Conclusion:1. Global primary treated drug-resistant TB factor is divided into Isoniazid-Streptomycin resistant factor, Rifampin-resistant factor, Rifampin-Ethambutoland-resistant factor, Ethambutoland-resistant factor, which is greatly associated with clinical medication history of anti-tuberculosis drugs.2. Global temperature and humidity have an effect on the spread and epidemic of primary treated drug-resistant TB.3. The more government health spending and the more perfect medical security system, the lower the resistance rates of various forms primary treated drug-resistant TB, on the contrary, the less government health spending and less pefect medical security system, the higher they are.