Demographic characteristics of TB cases
During 2012–2022, a total of 27,572 TB cases in Hangzhou underwent species identification of mycobacteria and DST, 464 were diagnosed with ORR-TB, 1,119 with MDR-TB, 1,135 with HR-TB, 17 with XDR-TB, 12 with Pre-XDR-TB, and 18,380 with SHR. A total of 6,446 cases were excluded from the study, including 1,418 cases of non-tuberculosis mycobacteria and 4,964 cases with incomplete DST results or logical errors. Consequently, the study included a total of 21,127 cases.
Among the 21,127 cases included in the study, the mean age was 51.5 ± 20.9 years. Of these cases, 14,716 (69.7%) were male and 6,411 (30.3%) were female. The majority of cases, 20,927 (99.1%), belonged to the Han ethnicity, while 200 (0.9%) belonged to other ethnic minorities. In terms of occupation, 13,028 (61.7%) were workers, farmers, or migrant workers, and 8,099 (38.3%) had other occupations. Regarding registered residence, 15,353 (72.7%) had Hangzhou Hukou (registered residence), while 5,774 (27.3%) did not. In terms of TB treatment history, 3,488 (16.5%) had previous TB treatment, while 17,639 (83.5%) had no previous TB treatment history.
Drug resistance patterns of TB cases in Hangzhou
Out of the 21,127 cases, 1,119 (5.3%) were diagnosed with MDR-TB, 464 (2.2%) with ORR-TB, 17 (0.08%) with XDR-TB, 12 (0.06%) with Pre-XDR-TB, and 1,135 (5.37%) with HR-TB. Significant declines were observed for rates of MDR, ORR, XDR, Pre-XDR and HR from 2012 to 2022 (P < 0.01) (Table 1).
Table 1
Drug resistance patterns of TB patients in Hangzhou City during 2012–2022
Year | No. of patients | MDR(%) | ORR(%) | XDR(%) | Pre-XDR(%) | HR(%) | SHR (%) |
2012 | 1321 | 153(11.58) | 26(1.97) | 1(0.08) | 0(0) | 132(9.99) | 1009(76.38) |
2013 | 1078 | 116(10.76) | 13(1.21) | 6(0.56) | 0(0) | 64(5.94) | 879(81.54) |
2014 | 1099 | 90(8.19) | 51(4.64) | 0(0) | 0(0) | 61(5.55) | 897(81.62) |
2015 | 1365 | 101(7.4) | 30(2.2) | 0(0) | 0(0) | 92(6.74) | 1142(83.66) |
2016 | 1142 | 88(7.71) | 17(1.49) | 2(0.18) | 0(0) | 107(9.37) | 928(81.26) |
2017 | 1556 | 107(6.88) | 28(1.8) | 2(0.13) | 0(0) | 100(6.43) | 1319(84.77) |
2018 | 2486 | 86(3.46) | 66(2.65) | 2(0.08) | 0(0) | 147(5.91) | 2185(87.89) |
2019 | 2938 | 100(3.4) | 46(1.57) | 3(0.1) | 0(0) | 125(4.25) | 2664(90.67) |
2020 | 2645 | 102(3.86) | 44(1.66) | 0(0) | 0(0) | 129(4.88) | 2370(89.6) |
2021 | 2770 | 116(4.19) | 48(1.73) | 1(0.04) | 0(0) | 117(4.22) | 2488(89.82) |
2022 | 2727 | 60(2.2) | 95(3.48) | 0(0) | 12(0.44) | 61(2.24) | 2499(91.64) |
Total | 21127 | 1119(5.3) | 464(2.2) | 17(0.08) | 12(0.06) | 1135(5.37) | 18380(87) |
χ2 | | 327.1 | 74.8 | 39.3 | 81.0 | 170.4 | |
P | | < 0.0001 | < 0.0001 | < 0.0001 | < 0.0001 | < 0.0001 | |
The MDR rate among cases with previous TB treatment history was 18.0%, while the MDR rate among cases without previous TB treatment history was 2.8%, significant difference was observed between the two groups (χ2 = 1351.1, P < 0.0001).
Ecdemic MDR-TB in Hangzhou during 2012–2022
Of the 1,119 MDR-TB cases, 604 (54.0%) had Hangzhou Hukou and were considered local MDR-TB cases. The remaining 515 (46%) cases did not have Hangzhou Hukou and were classified as ecdemic MDR-TB cases.
The MDR rate among the immigrant cases was 8.9%, significantly higher than the MDR rate among the local cases, which was 3.9% (χ2 = 207.9, p < 0.0001).
No significant difference was observed in the proportion of ecdemic and local MDR-TB from 2012 to 2022 (Table 2).
Among the 515 ecdemic MDR-TB cases, 277 (53.8%) were from other prefectures in Zhejiang Province, 35 (6.8%) were from Anhui Province, 33 (6.4%) were from Jiangxi Province, 21 (4.1%) were from Sichuan Province, and 149 (28.9%) were from other provinces in China.
Table 2
Ecdemic and local MDR-TB in Hangzhou City during 2012–2022
Year | Ecdemic MDR-TB(%) | Local MDR-TB(%) | Total |
2012 | 70(45.8) | 83(54.2) | 153 |
2013 | 53(45.7) | 63(54.3) | 116 |
2014 | 39(43.3) | 51(56.7) | 90 |
2015 | 48(47.5) | 53(52.5) | 101 |
2016 | 49(55.7) | 39(44.3) | 88 |
2017 | 42(39.3) | 65(60.7) | 107 |
2018 | 33(38.4) | 53(61.6) | 86 |
2019 | 43(43) | 57(57) | 100 |
2020 | 57(55.9) | 45(44.1) | 102 |
2021 | 55(47.4) | 61(52.6) | 116 |
2022 | 26(43.3) | 34(56.7) | 60 |
χ2 | 12.3 | |
P | 0.2659 | |
Of the 515 ecdemic MDR-TB cases, 207 (40.2%) were currently residing in Hangzhou. Among these cases, 25 (12.1%) were from Anhui Province, 25 (12.1%) were from Jiangxi Province, 23 (11.1%) were from other prefectures in Zhejiang Province, 15 (7.2%) were from Sichuan Province, and 119 (57.5%) were from other provinces in China (Fig. 1).
Among the 207 ecdemic MDR-TB cases residing in Hangzhou, 36 (17.4%) lived in Xiaoshan District, 30 (14.5%) lived in Shangcheng District, 25 (12.1%) lived in Linping District, 24 (11.6%) lived in Yuhang District, 20 (9.7%) lived in Gongshu District, and 72 (34.6%) lived in other districts in Hangzhou. There were no ecdemic MDR-TB cases in Chunan County and West Lake Scenic District (WLSD) (Fig. 1).
Among the 207 ecdemic MDR-TB cases, those from Anhui province were distributed across multiple districts in Hangzhou city. Cases from Jiangxi province predominantly flowed into Linping District, Yuhang District, and Binjiang District. Cases from Sichuan province predominantly flowed into Shangcheng District and Xiaoshan District. Cases from other prefectures in Zhejiang province predominantly flowed into Gongshu District and Xihu District (Fig. 1).
Ecdemic MDR-TB accounted for 52.4% of all MDR-TB cases in Binjiang District, the proportions were 38.1%, 37.9%, and 35.2% for Qiantang District, Xiaoshan District, and Linping District, respectively (Table 3).
Table 3
Proportion of ecdemic and MDR-TB in districts of Hangzhou during 2012–2022
District/County | ecdemic MDR-TB(%) | Local MDR-TB(%) | Total |
Binjiang | 11(52.4) | 10(47.6) | 21 |
Qiantang | 16(38.1) | 26(61.9) | 42 |
Xiaoshan | 36(37.9) | 59(62.1) | 95 |
Linping | 25(35.2) | 46(64.8) | 71 |
Xihu | 17(32.1) | 36(67.9) | 53 |
Yuhang | 24(30.4) | 55(69.6) | 79 |
Shangcheng | 30(28.6) | 75(71.4) | 105 |
Gongshu | 20(27.4) | 53(72.6) | 73 |
Fuyang | 15(26.8) | 41(73.2) | 56 |
Linan | 6(13) | 40(87) | 46 |
Jiande | 4(7.5) | 49(92.5) | 53 |
Tonglu | 3(7.3) | 38(92.7) | 41 |
Chun’an | 0(0) | 76(100) | 76 |
WLSD | 0(0) | 0(0) | 0 |
Total | 207(25.5) | 604(74.5) | 811 |