Predictors and Trends of MDR/RR-TB in Shenzhen China: A Retrospective 2012–2020 Period Analysis

Figures & data

Table 1 Diagnosis and Treatment Enrollment Cascade for MDR/RR-TB in Shenzhen, 2012–2020 [n (%)]

Year	TB Case Notification Rate (Per 100,000)	Number of Culture-Positive Strains	Number of MTB with DST Results	Number of Diagnosed RR-TB	Number of Diagnosed MDR-TB	Proportion of MDR-TB in RR-TB	Number of Patients Enrolled on MDR-TB Treatment	Number of Successful Treated Patients
2012	47.5	1747	1690 (96.7)	106 (6.3)	77 (4.6)	72.6%	38 (49.4)	24 (63.1)
2013	42.5	1964	1880 (95.7)	147 (7.8)	107 (5.7)	72.8%	55 (51.4)	41 (74.5)
2014	46.3	1838	1749 (95.2)	118 (6.8)	91 (5.2)	77.1%	37 (40.7)	27 (73.0)
2015	48.0	1777	1696 (95.4)	115 (6.8)	87 (5.1)	75.7%	47 (54.0)	32 (68.0)
2016	45.8	1846	1748 (94.7)	154 (8.8)	109 (6.2)	70.8%	55 (50.5)	40 (72.7)
2017	42.6	2740	2448 (89.3)	248 (10.1)	201 (8.2)	81.0%	111 (55.2)	77 (69.4)
2018	42.7	3069	2795 (91.1)	259 (9.3)	187 (6.7)	72.2%	133 (71.1)	97 (72.9)
2019	42.2	3337	3108 (93.1)	269 (8.7)	161 (5.2)	59.9%	112 (69.6)
2020	39.4	3049	2837 (93.0)	214 (7.5)	122 (4.3)	57.0%	86 (70.5)
Total	45.2	21,367	19,951 (93.4)	1630 (8.2)	1142 (5.7)	70.1%	674 (59.0)	338 (71.0)

Notes: MDR-TB refers to TB resistant to at least INH and RMP, while RR-TB refers to TB resistant to at least RMP and includes MDR-TB.

Abbreviations: TB, tuberculosis; MTB, Mycobacterium tuberculosis; MDR, multidrug-resistant TB; RR-TB, rifampicin-resistant TB.

Figure 1 Study flow diagram.

Table 2 Drug Resistance Patterns of 19,951 MTB Cases Stratified by Residential Status [n (%)]

Items	New Cases (n=18,296)			P values	Previously Treated Cases (n=1655)			P values
	Total	Migrants	Residents		Total	Migrant	Residents
Mono-INH	923 (5.0)	825 (5.1)	98 (5.0)	0.02	96 (5.8)	85 (5.9)	11 (4.9)	0.46
Mono-RMP	376 (2.1)	326 (2.0)	50 (2.5)		112 (6.8)	102 (7.1)	10 (4.5)
Susceptible*	16,304 (89.1)	14,559 (89.3)	1745 (87.6)		998 (60.3)	859 (60.0)	139 (62.3)
MDR	693 (3.8)	595 (3.6)	98 (4.9)		449 (27.1)	386 (27.0)	63 (28.3)
RR-TB	1069 (5.8)	921 (5.7)	148 (7.4)	0.01	561 (33.9)	488 (34.1)	73 (32.7)	0.74

Note: *Susceptible to INH and RMP; MDR-TB refers to TB resistant to at least INH and RMP, while RR-TB refers to TB resistant to at least RMP and includes MDR-TB.

Abbreviations: TB, tuberculosis; INH, isoniazid; RMP, rifampicin; MDR, multidrug-resistant TB; MTB, Mycobacterium tuberculosis.

Table 3 RR-TB and MDR-TB Rates Among 19,951 MTB Patients in Shenzhen, 2012–2020

Characteristics	Total [n (%)]	RR-TB		MDR-TB
		n (%)	P values	n (%)	P values
–	19,951 (100.0)	1630 (8.2)	–	1142 (5.7)	–
Gender
Male	13,110 (65.7)	1091 (8.3)	0.06	755 (5.8)	0.08
Female	6841 (34.3)	539 (7.9)		387 (5.7)
Age-groups (years)
≤ 30	5810 (29.1)	437 (7.5)		306 (5.3)
31–40	6280 (31.4)	548 (8.7)		397 (6.3)
41–50	3370 (16.9)	280 (8.3)	0.01	187 (5.6)	0.01
51–60	2469 (12.4)	213 (8.6)		142 (5.8)
≥61	2022 (10.1)	152 (7.5)		110 (5.4)
Occupation
Housework service /unemployment	8802 (44.1)	735 (8.4)		514 (5.8)
Workers	6486 (32.5)	447 (6.9)		306 (4.7)
Staff officers	1330 (6.7)	126 (9.5)		93 (7.0)
Business service	1218 (6.1)	128 (10.5)	< 0.001	91 (7.5)	< 0.001
Teachers/students	717 (3.6)	68 (9.5)		55 (7.7)
Retired	475 (2.4)	40 (8.4)		25 (5.3)
Others	923 (4.6)	86 (9.3)		58 (6.3)
Residential status
Internal migrants	17,737 (88.9)	1409 (7.9)	0.004	981 (5.5)	0.001
Local residents	2214 (11.1)	221 (10.0)		161 (7.3)
Treatment history
New cases	18,296 (91.7)	1069 (5.8)	< 0.001	693 (3.8)	< 0.001
Previously treated cases	1655 (8.3)	561 (33.9)		449 (27.1)
Residence in the city center
Yes	5979 (30.0)	497 (8.3)	0.50	353 (5.9)	0.64
No	13,972 (70.0)	1133 (8.1)		789 (5.7)

Note: MDR-TB refers to TB resistant to at least INH and RMP, while RR-TB refers to TB resistant to at least RMP and includes MDR-TB.

Abbreviations: TB, tuberculosis; MDR, multidrug-resistant TB; RR-TB, rifampicin-resistant TB.

Table 4 Multivariate Analysis on Predictors of MDR-TB and RR-TB

Characteristics	MDR-TB vs Susceptible-TB*		RR-TB vs Susceptible TB*
	aORs (95% CI)	P values	aORs (95% CI)	P values
Age-groups (years)
≤ 30	1.00		1.00
31–40	1.14 (0.98,1.36)	0.12	1.13 (0.98,1.3)	0.10
41–50	0.84 (0.77,1.03)	0.12	0.91 (0.77,1.09)	0.36
51–60	0.84 (0.75,1.06)	0.15	0.91 (0.75,1.1)	0.35
≥ 61	0.63 (0.53,0.84)	0.002	0.67 (0.53,0.84)	0.001
Occupation
Housework service/unemployment	1.00		1.00
Workers	0.84 (0.72,0.99)	0.03	0.82 (0.72,0.94)	0.004
Staff officers	1.08 (0.83,1.4)	0.57	1.07 (0.86,1.34)	0.59
Business service	1.26 (0.97,1.63)	0.09	1.19 (0.92,1.55)	0.07
Teachers/students	1.47 (1.06,2.04)	0.02	1.16 (0.87,1.55)	0.32
Retired	1.02 (0.63,1.66)	0.87	1.09 (0.73,1.61)	0.64
Others	1.09 (0.8,1.49)	0.50	1.12 (0.87,1.44)	0.33
Residential status
Internal migrants	0.77 (0.63,0.93)	0.02	0.83 (0.71,0.98)	0.03
Local residents	1.00		1.00
Treatment history
New cases	1.00		1.00
Previously treated cases	10.5 (9.1–12.2)	< 0.001	9.04 (7.98,10.25)	< 0.001

Notes: *Susceptible to INH and RMP. Logistic regression models were used for multivariate analysis on predictors of MDR/RR-TB and MDR-TB, and all models were adjusted for gender, age-group, occupation, migrant status, treatment history, year, and city center residence. We assessed interactions between migrant status, treatment history, age-groups, and residence and found them to be nonsignificant statistically (all P values > 0.05). Gender and city center residence were not statistically significant in the final models. MDR-TB refers to TB resistant to at least INH and RMP, while RR-TB refers to TB resistant to at least RMP and includes MDR-TB.

Abbreviations: TB, tuberculosis; MDR, multidrug-resistant TB; RR-TB, rifampicin resistant TB; aORs, adjusted odds ratios.

Figure 2 Trends in RR-TB and MDR-TB in Shenzhen during the 2012–2020 period.

Notes: MDR-TB refers to TB resistant to at least INH and RMP, while RR-TB refers to TB resistant to at least RMP and includes MDR-TB; therefore, RR-TB is grouped together with MDR-TB as MDR/RR-TB. (A) The overall proportion of MDR-TB increased during the 2012–2017 period (P_trend =0.02) and decreased during the 2017–2020 period (P_trend =0.01). The proportion of MDR/RR-TB also increased during the 2012–2017 period (P_trend =0.045) and decreased during the 2017–2020 period (P_trend =0.26). (B) In new cases, the proportion of MDR-TB increased during the 2012–2018 period (P_trend =0.01) and decreased during the 2018–2020 period (P_trend =0.04). The proportion of MDR/RR-TB also increased during the 2012–2018 period (P_trend =0.02) and decreased during the 2018–2020 period (P_trend =0.50). (C) In previously treated cases, the proportion of MDR-TB increased during the 2012–2017 period (P_trend =0.06) and decreased during the 2017–2020 period (P_trend =0.03). The proportion of MDR/RR-TB increased during the 2012–2017 period (P_trend =0.22) and decreased during the 2017–2020 period (P_trend =0.07).