The Association Between Household Financial Burden and Patient Mobility and Their Impact on Loss to Follow-Up Among Multidrug-Resistant Tuberculosis Patients in Guizhou, China

Yun Wang; Zhongfeng Huang; Huijuan Chen; Ye Yuan; Edward B McNeil; Xiaolong Lu; Aihua Zhang

doi:10.2147/RMHP.S400667

The Association Between Household Financial Burden and Patient Mobility and Their Impact on Loss to Follow-Up Among Multidrug-Resistant Tuberculosis Patients in Guizhou, China

Risk Manag Healthc Policy. 2023 May 17:16:909-919. doi: 10.2147/RMHP.S400667. eCollection 2023.

Authors

Yun Wang¹, Zhongfeng Huang², Huijuan Chen³, Ye Yuan², Edward B McNeil⁴, Xiaolong Lu⁵, Aihua Zhang¹

Affiliations

¹ Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.
² Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou, People's Republic of China.
³ Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, People's Republic of China.
⁴ Department of Infectious Diseases, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, People's Republic of China.
⁵ School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.

Abstract

Purpose: We aimed to assess the household financial burden due to multidrug-resistant tuberculosis (MDR-TB) treatment and its predictors, examine its association with patient mobility, and test their impact on patient loss to follow-up (LTFU).

Methods: A cross-sectional study combining follow-up data collection was conducted at the largest designated MDR-TB hospital in Guizhou. Data were collected from medical records and questionnaires. Household financial burden was measured by the incidence of 2 indicators: catastrophic total costs (CTC) and catastrophic health expenditure (CHE). Mobility was classified as mover or non-mover after the patient's address was verified twice. A multivariate logistic regression model was used to identify associations between variables. Model I and Model II were separated by CHE and CTC.

Results: Out of 180 households, the incidence of CHE and CTC was 51.7% and 80.6%, respectively. Families with low income and patients who were primary income earners were significantly associated with catastrophic costs. 42.8% of patients were movers. Patients from households with CHE (OR_adj=2.2, 95% CI: 1.1-4.1) or with CTC (OR_adj=2.6, 95% CI: 1.1-6.3) were more likely to move. Finding a job against financial difficulty (58.4%) was the top reason for movers. 20.0% of patients experienced LTFU. Patients from households with catastrophic payments (CHE: OR_adj=4.1, 95% CI 1.6-10.5 in Model I; CTC: OR_adj=4.8, 95% CI 1.0-22.9 in Model II), patients who were movers (OR_adj=6.1, 95% CI 2.5-14.8 in Model I; OR_adj=7.4, 95% CI 3.0-18.7 in Model II) and primary income earners (OR_adj=2.5, 95% CI: 1.0-5.9 in Model I; OR_adj=2.7, 95% CI 1.1-6.6 in Model II) had an increased risk of LTFU.

Conclusion: There is a significant association between household financial burden due to MDR-TB treatment and patient mobility in Guizhou. They impact patients' treatment adherence and cause LTFU. Being a primary breadwinner increases the risk for catastrophic household payments and LTFU.

Keywords: Guizhou; MDR-TB; household catastrophic costs; loss to follow-up; migration.

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant number 81860591), Guizhou Provincial Science and Technology Projects (grant number ZK[2022]-386 general project), and the Doctor Initiation Fund of Guizhou Medical University (grant number [2020]070). The funding body had no role in the design of the study; collection, analysis and interpretation of the data or in the writing of the manuscript.