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中国贵州省耐多药结核病患者家庭经济负担与患者流动的关系及其对失访的影响
Authors Wang Y, Huang Z, Chen H, Yuan Y, McNeil EB , Lu X, Zhang A
Received 7 December 2022
Accepted for publication 4 May 2023
Published 17 May 2023 Volume 2023:16 Pages 909—919
DOI https://doi.org/10.2147/RMHP.S400667
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Mecit Can Emre Simsekler
Purpose: We aimed to assess the household financial burden due to multidrug-resistant tuberculosis (MDR-TB) treatment and its predictors, examine its association with patient mobility, and test their impact on patient loss to follow-up (LTFU).
Methods: A cross-sectional study combining follow-up data collection was conducted at the largest designated MDR-TB hospital in Guizhou. Data were collected from medical records and questionnaires. Household financial burden was measured by the incidence of 2 indicators: catastrophic total costs (CTC) and catastrophic health expenditure (CHE). Mobility was classified as mover or non-mover after the patient’s address was verified twice. A multivariate logistic regression model was used to identify associations between variables. Model I and Model II were separated by CHE and CTC.
Results: Out of 180 households, the incidence of CHE and CTC was 51.7% and 80.6%, respectively. Families with low income and patients who were primary income earners were significantly associated with catastrophic costs. 42.8% of patients were movers. Patients from households with CHE (ORadj=2.2, 95% CI: 1.1– 4.1) or with CTC (ORadj=2.6, 95% CI: 1.1– 6.3) were more likely to move. Finding a job against financial difficulty (58.4%) was the top reason for movers. 20.0% of patients experienced LTFU. Patients from households with catastrophic payments (CHE: ORadj=4.1, 95% CI 1.6– 10.5 in Model I; CTC: ORadj=4.8, 95% CI 1.0– 22.9 in Model II), patients who were movers (ORadj=6.1, 95% CI 2.5– 14.8 in Model I; ORadj=7.4, 95% CI 3.0– 18.7 in Model II) and primary income earners (ORadj=2.5, 95% CI: 1.0– 5.9 in Model I; ORadj=2.7, 95% CI 1.1– 6.6 in Model II) had an increased risk of LTFU.
Conclusion: There is a significant association between household financial burden due to MDR-TB treatment and patient mobility in Guizhou. They impact patients’ treatment adherence and cause LTFU. Being a primary breadwinner increases the risk for catastrophic household payments and LTFU.
Keywords: household catastrophic costs, migration, loss to follow-up, Guizhou, MDR-TB