An Investigation On The Epidemic Characteristics And Direct Economic Burden Of Tuberculosis Patients In Anhui Province

Part ?: Analysis of epidemic characteristics of PulmonaryTuberculosis in Anhui Province from 2005 to 2018 Objectives To analyze the prevalence of pulmonary tuberculosis in Anhui Province,describe the characteristics of reported incidence of pulmonary tuberculosis,discuss the influencing factors of reported incidence of pulmonary tuberculosis,and provide scientific basis for the formulation of tuberculosis control strategy in the future.Methods The descriptive epidemiology method was used to analyze the data of tuberculosis patients reported by the management information system of infectious diseases in Anhui Province from 2005 to 2018.Results 591 144 cases of pulmonary tuberculosis were reported in Anhui Province during 2005 – 2018 years.From 2005 to 2011,the proportion of smear positive patients was above 45 percent.Since 2012,the proportion of smear positive patients has decreased obviously and showed a decreasing trend year by year.At the same time,the proportion of smear negative patients have increased year by year.The reported incidence of pulmonary tuberculosis decreased from 97.9 / 100000 in 2005 to 49.9 / 100000 in 2018,with an average annual decrease of 3.4%.The reported incidence was the highest in the group over 65 years old,the sex ratio was 2.70?1,and the number of reported cases among farmers accounted for 73.2% of the total number of cases.The number of pulmonary tuberculosis patients reported in our province has obvious time regularity,with the annual cycle as the cycle,the reported incidence rate peaks in March and April.The reported incidence of pulmonary tuberculosis is related to the per capita gross domestic product(GDP)and rural per capita health care expenditure in our province.From 2005 to 2018,a total of 542455 cases of pulmonary tuberculosis patients were registered in the province.The registration management rate was 91.76%(542 455/591 144),the outcome rate of treatment was 86.90%,and the success rate of treatment was 80.77%.A total of 1369 patients with mdr-tb were registered in 2018,the treatment rate was 84.15%,and the success rate of treatment in 2015-2016 was 52.31%.Conclusion The incidence of tuberculosis reported by patients shows a downward trend year by year.The male,the elderly over 65 years old,farmers and poor people are the key groups of tuberculosis control,spring is the season of high incidence of tuberculosis,and the mountainous area of southern Anhui is a high reported incidence area.It is necessary to improve the diagnosis level of designated medical institutions for tuberculosis at the grass-roots level,to reduce the proportion of overdiagnosis of tuberculosis,and strengthen the measures of tuberculosis prevention and control in key groups and key areas.This paper investigateds and analyzed the related factors affecting the discovery and compliance of multi-drug resistance,such as the population characteristics of drug-resistant patients,the treatment management process and the economic burden of diseases,and finds out the factors that affect the detection rate and treatment success rate,so as to speed up the discovery of drug-resistant patients,standardize the treatment and finally achieve the purpose of reducing the spread of drug-resistant tuberculosis,which is the focus of our next step of prevention and control.Part ?: Direct Economic Burden of Tuberculosis and Multi-drug resistant Tuberculosis Patients in Anhui ProvinceObjectives The economic burden TB patients and mdr-tb patients in the process of diagnosis and treatment was investigated and analyzed in order to further improve the cure rate of multi-drug resistant tuberculosis and the quality of life of patients in our province.Methods The direct economic burden of disease research adopted the method of stratified cluster sampling system,according to the municipal level of GDP per capital and distribution layer,and considering our province baseline survey data,various cities of multi-drug resistant tuberculosis control work level factors.The investigation was carried out in Hefei,Chuzhou,Bengbu,Fuyang,Huainan,Wuhu,Tongling and Huaibei cities.A total of 143 cases of multi-drug resistant tuberculosis patients and 160 normal pulmonary tuberculosis patients were surveyed.The data was statistically analyzed by spss16.0,and the data which did not conform to the normal distribution were expressed by M(P25,P75).The rank sum test was used for the comparison between the two groups,and the Spearman analysis was used to determine the degree of correlation.Results The sex ratio of male to female was 3.33:1 in MDR-TB patients,the sex ratio of male to female was 2.27:1 in normal pulmonary tuberculosis patients.There are significant differences in the type of medical insurance,the annual income of the family,the situation of the family's liabilities due to illness,whether it is identified as the poor households.The per capita income of the two groups of patients after illness was 19218 yuan,lower than the per capita disposable annual income of 21863 yuan reported by Anhui Province in 2017.The annual household income reduction of the patients before and after the illness was higher in that of the multi-drug-resistant patients group.About one third of the patients in the two groups had a decrease in the annual income of the family after the illness,and the average annual income of the multi-drug-resistant patients decreased from 54,293 yuan before the illness to 44,893 yuan,a decrease of 17.31%.The outpatient expenses of multi-drug-resistant patients were 5.83 times that of ordinary patients,and the hospitalization expenses were 2.58 times that of ordinary patients.The direct medical expenses of patients with multi-drug-resistant pulmonary tuberculosis was related to the number of patient visiting institutions,the type of diagnosis institution,the type of treatment institution and the multi-drug-resistant treatment program,while the indirect economic expense was related to the patient's age,education level,occupation and the type of multi-drug-resistant diagnosis institution.Conclusion Controlling the TB outbreaks,especially drug-resistant tuberculosis,requires government departments to increase the investment in tuberculosis treatment management,meanwhile,improve the medical security policy to effectively reduce the medical burden of drug-resistant patients,and combine the accurate poverty alleviation policy to improve the overall social and economic level to fundamentally solve the phenomenon of diseases caused by poverty.