Ma Xiaoxue, Huang Aijue, Chen Huijuan, Zhou Jian, He Yuying, Wang Weibing, Du Rong, Guo Xueli, Zhao Qi, Li Jinlan
Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China.
School of Public Health, Fudan University, Shanghai, China.
Front Public Health. 2025 May 30;13:1510195. doi: 10.3389/fpubh.2025.1510195. eCollection 2025.
In accordance with the World Health Organization (WHO)'s "End TB Strategy," which aims to eradicate catastrophic expenditures faced by TB-affected families, we intend to thoroughly investigate and comprehend the economic burden, catastrophic expenditures, and contributing factors pertaining to non-drug-resistant tuberculosis patients' families in Guizhou Province. Our goal is to formulate policy recommendations that can effectively alleviate the financial strain on these patients and their families.
The pulmonary tuberculosis cases, which were non-drug-resistant, registered across the province during May-June 2020, and successfully treated at the time of the survey, underwent questionnaire interviews conducted through probability proportional sampling. Utilizing the WHO methodology, the household economic burden borne by these patients was computed, with the mean and median (interquartile range), abbreviated as "M (IQR)," employed to describe the economic burden, and the proportion (%) used to depict catastrophic expenditures. Further analysis of the factors influencing catastrophic expenditures within these families was conducted using chi-squared ( ) tests and binary logistic regression.
The average total out-of-pocket expenses (OOP) incurred by 2,283 non-drug-resistant pulmonary tuberculosis patients in Guizhou Province amounted to 10,581.82 RMB ($1453.11), with a median expenditure of 5,277 RMB (IQR: 2,110-12,352 RMB). Notably, indirect expenses comprised 58.07% of the total expenditure. Taking the time of diagnosis as the cut-off point, the majority of these expenses occurred during the treatment phase, but the before diagnosis stage also imposed a significant economic burden, averaging 3,191.58 RMB ($438.27). Among the 2,283 patients, 50.37% (1,150 patients) experienced catastrophic events due to their medical expenses. Key risk factors for these catastrophic events included poverty, employment status, before diagnosis visits, hospitalization, mobility issues, and delayed diagnosis.
The economic burden imposed on households by tuberculosis patients in the province remains considerable, with the indirect burden accounting for the lion's share. The likelihood of catastrophic expenditures persists, significantly influenced by factors such as poverty, hospitalization, delayed diagnoses, and before diagnosis visits. Recommendations include reinforcing targeted public health education, enhancing the diagnostic and therapeutic capabilities of medical institutions, regulating their practices, curbing unnecessary hospitalizations, and instituting a long-term framework aimed at alleviating the indirect economic burden. By doing so, we can collaboratively diminish the economic strain on patients and mitigate the risk of catastrophic expenditures, ultimately striving for the achievement of zero catastrophic expenditures among households.
按照世界卫生组织（WHO）的“终止结核病战略”，该战略旨在消除结核病患者家庭面临的灾难性支出，我们打算全面调查并了解贵州省耐多药结核病患者家庭的经济负担、灾难性支出及相关影响因素。我们的目标是制定能有效减轻这些患者及其家庭经济压力的政策建议。
对2020年5月至6月期间在全省登记且调查时已成功治愈的非耐多药肺结核病例，采用概率比例抽样进行问卷调查。利用WHO的方法计算这些患者家庭的经济负担，用均值和中位数（四分位间距），简称为“M（IQR）”来描述经济负担，用比例（%）来描述灾难性支出。使用卡方（ ）检验和二元逻辑回归对这些家庭中影响灾难性支出的因素进行进一步分析。
贵州省2283例非耐多药肺结核患者的平均自付总费用（OOP）达10581.82元人民币（1453.11美元），中位数支出为5277元人民币（IQR：2110 - 12352元人民币）。值得注意的是，间接费用占总支出的58.07%。以确诊时间为分界点，这些费用大多发生在治疗阶段，但确诊前阶段也带来了巨大经济负担，平均为3191.58元人民币（438.27美元）。在2283例患者中，50.37%（1150例患者）因医疗费用遭遇灾难性事件。这些灾难性事件的关键风险因素包括贫困、就业状况、确诊前就诊次数、住院情况、行动不便及诊断延误。
该省结核病患者给家庭带来的经济负担依然沉重，其中间接负担占比最大。灾难性支出的可能性仍然存在，受贫困、住院、诊断延误和确诊前就诊次数等因素影响显著。建议包括加强有针对性的公共卫生教育、提高医疗机构的诊断和治疗能力、规范其医疗行为、遏制不必要的住院情况，并建立一个旨在减轻间接经济负担的长期框架。通过这样做，我们可以共同减轻患者的经济压力，降低灾难性支出的风险，最终努力实现家庭灾难性支出为零的目标。
