title: Comparison of characteristics and mortality in multidrug resistant (MDR) and non-MDR tuberculosis patients in China.
abstract: BACKGROUND
  We conducted a cohort study to compare the characteristics of MDR-TB with non-MDR-TB patients and to measure long term (9-year) mortality rate and determine factors associated with death in China.
  
  
  METHODS
  We reviewed the medical records of 250 TB cases from a 2001 survey to compare 100 MDR-TB patients with 150 non-MDR-TB patients who were treated in 2001-2002. Baseline attributes extracted from the records were compared between the two cohorts and long-term mortality and risk factors were determined at nine-year follow-up in 2010.
  
  
  RESULTS
  Among the 234 patients successfully followed up, 63 (26.9%) were female and 171 (73.1 %) were male. MDR-TB patients had poorer socioeconomic status compared to non-MDRTB. Nine years after the diagnosis of TB, 69 or 29.5 % of the 234 patients had died (32 or 21.6 % of non-MDR-TB versus 37 or 43.0 % of MDR-TB) and the overall mortality rate was 39/1000 per year (PY) (27/1000 PY among non-MDR versus 63/1000 PY among MDR-TB). Factors associated with death included: MDR status (hazard ratio (HR): 1.86; CI: 1.09-3.13), limited education of primary school or lower (HR: 2.51; CI 1.34-4.70) and received TB treatment during the nine-year period (HR 1.82; 95 % CI 1.02-3.26).
  
  
  CONCLUSIONS
  MDR-TB was a strong predictor for poor long-term outcome. High quality diagnosis and treatment must be ensured. Greater reimbursement or free treatment may be needed to provide access for the poor and vulnerable populations, and to increase treatment compliance.
authors.affiliation: National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, 2601, Australia. sunyanni72@hotmail.com.
authors.forename: Yanni
authors.initials: Y
authors.lastname: Sun
authors.affiliation: National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, 2601, Australia. david.harley@anu.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Harley
authors.affiliation: School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Australia. h.vally@latrobe.edu.au.
authors.forename: Hassan
authors.initials: H
authors.lastname: Vally
authors.affiliation: National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, 2601, Australia. adrian.sleigh@anu.edu.au.
authors.forename: Adrian
authors.initials: A
authors.lastname: Sleigh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000401:mortality; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000401:mortality*; D055815:Young Adult