The married middle working class turned out to be the most financially fragile group when facing multidrug-resistant tuberculosis in China cities

• DOI: 10.21203/rs.2.19439/v1
• Publication Date: 2019-12-23T18:26:24Z
• Authors: Peize Zhang; Guanghui Xu; Yanhua Song; Jie Tan; Tao Chen; Guofang Deng
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 1. No poverty; 3. Good health

Abstract INTRODUCTION With the emergence of multi-drug resistant tuberculosis and the threat it poses to public health, and the consequential cost involved in its treatment, constant effort has been put on evaluating and improving patient care to avoid treatment interference due to impoverishment of the household.OBJECTIVE The aim of this study was to analyze socioeconomic burdens and other difficulties MDR-TB patients in cities are facing to identify major obstacles and which group of patients are most affected.METHODS Face-to-face and phone-call interviews were conducted in early 2018 to follow up with patients newly diagnosed with MDR-TB in 2017 in three tuberculosis clinics in China. Demographic data and information on their medical care, insurance coverage, medical expenses were collected and analyzed.RESULTS A total of 144 newly-diagnosed MDR-TB cases were reviewed during the study period, among them 38 lost follow-up and 29 patients refused to participate. Eventually, 77 patients with MDR-TB were included in this study. 61 of these patients were hospitalized after MDR-TB diagnosis with an average hospital stay of 14.45 days, of them 57 were sputum positive on diagnosis. Ratio of home-discharged patients failing community care and returned to work were 48% and 8% for married and single persons ( p = 0.001). In terms of insurance coverage, proportion of patients went back to work were 23% with no insurance and/or NRCMS and 45% with UEBMI / URBMI and commercial insurance. Significant difference was shown between these two insurance coverage groups (χ 2 = 5.059, p = 0.033). Difficulties patients encountered were financial pressure (33%), psychological stress (26%), adverse drug reactions (23%), repulsive reaction to injections (17%). 48% of the patients spent over CNY2,000 (USD300) per month on TB treatment.CONCLUSION The married “middle working class” were found to be the most vulnerable group being affected financially. They have the highest tendency to fail community care schedule despite treatment status. It is of utmost urgency to enhance the current medical policy to cater for this group and improve treatment adherence.