Epidemiology of extrapulmonary tuberculosis among pediatric inpatients in mainland China: a descriptive, multicenter study

Ping Chu; Yan Chang; Xuan Zhang; Shujing Han; Yaqiong Jin; Yongbo Yu; Yeran Yang; Guoshuang Feng; Xinyu Wang; Ying Shen; Xin Ni; Yongli Guo; Jie Lu; Futang Research Center of and Pediatric Development (FRCPD)

doi:10.1080/22221751.2022.2054367

Epidemiology of extrapulmonary tuberculosis among pediatric inpatients in mainland China: a descriptive, multicenter study

Emerg Microbes Infect. 2022 Dec;11(1):1090-1102. doi: 10.1080/22221751.2022.2054367.

Authors

Affiliations

¹ Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.
² Big Data and Engineering Research Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.
³ Department of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.
⁴ Department of Otolaryngology Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.

Abstract

ABSTRACTPediatric tuberculosis (TB) is a serious infectious disease that affects many children worldwide and is more likely to be extrapulmonary than adult TB. However, the clinical and epidemiological profile, and cost burden of pediatric extrapulmonary TB (EPTB) in China remain unknown. Here, we conducted a descriptive, multicenter study of pediatric TB patients from 22 hospitals across all six regions in China from October 2015 to December 2018. Of 4,654 patients, 54.23% (2,524) had pulmonary TB (PTB), 17.76% (827) had EPTB, and 28.00% (1,303) had concurrent extrapulmonary and pulmonary TB (combined TB). Compared with PTB, EPTB and combined TB were associated with lower hospitalization frequency (2.43 and 2.21 vs. 3.16 times), longer length of stay (10.61 and 11.27 vs. 8.56 days), and higher rate of discharge against medical advice (8.46% and 9.44% vs. 5.67%). EPTB was associated with higher mortality (0.97% vs. 0.24% and 0.31%), higher rate of low birth weight (17.69% vs. 6.79% and 6.22%), worse diagnosis at the first visit (21.16% vs. 34.67% and 44.47%), and worse hospitalization plan situation (4.35% vs. 7.81% and 7.44%), compared with PTB and combined TB. EPTB and combined TB had higher financial burdens (17.67% and 16.94% vs. 13.30%) and higher rates of catastrophic expenditure (8.22% and 9.59% vs. 5.03%), compared with PTB. Meningitis TB (34.18%) was the most frequent form of total extrapulmonary infection and had the highest cost burden and rate of catastrophic expenditure. In conclusion, improved screening approaches for pediatric EPTB are needed to reduce diagnostic challenges and financial burden.

Keywords: China; Extrapulmonary tuberculosis; children; epidemiology; inpatients.

Publication types

Multicenter Study

MeSH terms

Adult
Child
China / epidemiology
Humans
Inpatients
Retrospective Studies
Tuberculosis, Meningeal*
Tuberculosis, Pulmonary* / epidemiology

Grants and funding

This work was supported by National Natural Science Foundation of China: [Grant Number 81401739]; Beijing Hospitals Authority’ Ascent Plan: [Grant Number DFL20191201]; Beijing Hospitals Authority Clinical medicine Development of special funding: [Grant Number XMLX202121]; The Special Fund of The Pediatric Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals: [Grant Number XTCX201806]; Beijing Talent Training Funded Project: [Grant Number 2018000021469G277].