| Objective:With an aging population,China is facing a huge burden of elderly patients with tuberculosis(TB),which has become a significant obstacle for the China TB control.There is still little study on TB in the elderly in China so far.Thus,more research on the epidemiological characteristics and drug-resistance of newly-diagnosed TB among elderly will be necessary.Method:A retrospective study was conducted in Shandong,China from 2004 to 2019.We collected 12,661 newly-diagnosed TB cases,of which 4368 elderly(≥60 years)newly-diagnosed TB cases were involved.Clinical characteristics including age,sex,cavity,smoking,drinking,comorbidity and drug susceptibility data were collected from 36 TB prevention and control institutions of Shandong Province.Fisher’s exact test or Pearson’s chi-square test were used to compare the clinical characteristics between the non-elderly(<60 years)and the elderly(≥60 years)patients and drug-resistance patterns of drug-resistant tuberculosis(DR-TB)in the elderly,logistics models were used to explore the risk factors of newly-diagnosed TB and DR-TB in the elderly.Chi-square test for trends and linear regression in line charts and stacked bar charts were used to analyze the changes and temporal trend in quantity and proportions of the different resistance patterns over time.Result:Of 12661 newly-diagnosed TB patients,4368(34.50%)were elderly.The elderly new cases of TB were more likely than the non-elderly new cases of TB to be male(OR:2.045,95%CI:1.850-2.280),to have habits of smoking(OR:1.447,95%CI:1.300-1.611)and drinking(OR:1.144,95%CI:1.019-1.284),and to have chronic obstructive pulmonary disease(COPD)(OR:1.320,95%CI:7.457-17.183)and diabetes(OR:1.399,95%CI:1.186-1.651).Among 2351 elderly patients with newly-diagnosed DR-TB,the elderly DR-TB case-patients were more likely than the non-elderly DR-TB case patients to bemale(OR:2.048,95%CI:1.575-2.663),to have habits of smoking(OR:1.511,95%CI:1.169-1.954)to have COPD(OR:23.883,95%CI:7.193-79.305)and diabetes(OR:1.658,95%Cl:1.144-2.402).Among 4368 elderly patients with newly-diagnosed TB,the drug-resistant tuberculosis(DR-TB)and multi-resistant tuberculosis(MDR-TB)accounted for 17.19%and 2.29%,respectively.During 2004-2019,the proportions of MDR-TB,polydrug resistant tuberculosis(PDR-TB),rifampin(RFP)resistant tuberculosis increased by 160.00%,18.18%,231.82%,respectively and the rate of DR-TB among elderly patients with newly-diagnosed cavitary TB increased by 255%.Among the elderly with newly-diagnosed DR-TB during 2004-2019,the proportion of male(from 85.19 to 89.06),cavity(from 7.41 to 46.88),RFP-resistance(from 3.70 to 21.88),and streptomycin(SM)-resistance(from 37.04 to 62.5)increased significantly(P<0.05).And the proportion of female(from 14.81 to 10.94),non-cavity(from 92.59 to 32.81),INH-resistanc(from 66.67 to 57.81)decreased significantly(P<0.05).Conclusion:Among the elderly,the proportions of MDR-TB,PDR-TB,RFP-resistance and cavitary DR-TB increased significantly in Shandong.The pattern of DR-TB in Shandong changed from female,non-cavity and INH-resistant groups to male,cavity,RFP or SM-resistant groups from 2004 to 2019.For a better control on the elderly TB in the future,we should pay more attention to male,smoking,drinking,COPD and diabetes subgroups and take targeted measures to control these subgroups. |
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