Abstract:

Objective: To analyse the treatment outcomes and influencing factors of patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) aged 65 years and above in China from 2015 to 2021. Methods: The medical records of patients aged 65 years and older diagnosed with RR-PTB and treated nationwide from January 1, 2015, to December 31, 2021, were retrieved from the “Drug-Resistant Case Management” section of the “Surveillance Report Management” module within the “China Information System for Disease Control and Prevention”. Descriptive analysis was performed on the patients’ demographic characteristics, diagnostic and treatment details, and treatment outcomes. Univariate and multivariate logistic regression analysis were used to analyse the factors influencing treatment outcomes. Results: From 2015 to 2021, a total of 13806 RR-PTB patients aged 65 and above were registered nationwide, with an incidence rate of 1.16 per 100000 (13806/1191.33 million). The rate increased from 0.50 per 100000 (726/145.24 million) in 2015 to 1.37 per 100000 (2743/200.56 million) in 2021. The proportion of elderly RR-PTB patients among all RR-PTB patients was 16.15% (13806/85494), increasing from 13.24% (726/5484) in 2015 to 19.12% (2743/14348) in 2021. The treatment rate of registered patients was 80.18% (11070/13806), increasing from 58.13% (422/726) in 2015 to 90.01% (2469/2743) in 2021. The treatment success rate was 46.37% (5133/11070), increasing from 37.20% (157/422) in 2015 to 48.85% (1206/2469) in 2021, showing a significant upward trend ($χ^{2}_{trend}$ values were 96.329, 272.135, 919.021, and 30.029, with P-values all <0.001). Multivariate logistic regression analysis revealed that, relative to individuals aged 65-69, females, homemakers, and unemployed individuals, eastern region, primary treatment, and rifampicin monoresistance, those in older age groups (70-74, 75-79, and 80+), males, individuals engaged in agriculture, pastoralism, or fishing, residents of central and western regions, retreatment, with multidrug-resistant, pre-extensively drug-resistant, or extensively drug-resistant pulmonary tuberculosis exhibited significantly higher risks of treatment failure (OR=1.156, 95%CI: 1.055-1.268; OR=1.415, 95%CI: 1.269-1.578; OR=1.887, 95%CI: 1.655-2.154; OR=1.202, 95%CI: 1.101-1.312; OR=1.152, 95%CI: 1.037-1.279; OR=1.655, 95%CI: 1.503-1.823; OR=1.657, 95%CI: 1.494-1.837; OR=1.109, 95%CI: 1.028-1.197; OR=1.243, 95%CI: 1.147-1.346; OR=1.331, 95%CI: 1.015-1.752). Conclusion: The registration rate and proportion of elderly RR-PTB patients aged 65 and above in China have exhibited an upward trend. Although the treatment initiation rate among registered patients is relatively high, the treatment success rate remains suboptimal. Particular attention should be directed towards male patients, those aged 70 and above, individuals engaged in agriculture, pastoralism, or fishing, residents of central and western regions, patients with prior treatment history, as well as those diagnosed with multidrug-resistant tuberculosis, pre-extensively drug-resistant tuberculosis, or extensively drug-resistant tuberculosis.

Key words: Tuberculosis, Elderly, Rifampicin, Drug resistance, Treatment outcome, Factor analysis, statistical