ArticleFrontiers in public health2026
Severe pre-treatment attrition in the care cascade: clinical outcomes and risk factors among older MDR/RR-TB patients in China.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The rising global burden of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) coincides with rapid population aging. Older patients face unique challenges, yet age-stratified analyses of the MDR/RR-TB care cascade are lacking, obscuring the specific barriers they encounter. Objective: This study aimed to characterize the treatment cascade and identify factors associated with attrition among older MDR/RR-TB patients in China. Methods: We conducted a retrospective cohort study of 667 MDR/RR-TB patients aged ≥65 years in Guangdong Province, southern China (2010-2022). Using data from the national Tuberculosis Information Management System (TIMS), we constructed a care cascade to quantify attrition across four stages (diagnosis, treatment initiation, retention at 6 months, and treatment success) and three inter-stage gaps (attrition between successive stages). Separate multivariable logistic regression models identified factors associated with failure to initiate treatment and with poor outcomes. Results: Of the 667 diagnosed patients (median age 70), 500 (74.96%) initiated treatment, 406 (60.87% of diagnosed cases, 81.2% of treated cases) were retained at 6 months, and only 268 (40.18% of diagnosed cases, 53.6% of treated cases) achieved treatment success. Multivariable analysis showed that workers/farmers ( Conclusion: The MDR/RR-TB care cascade for older patients in China is marked by severe pre-treatment attrition. Targeted interventions, including scaling up rapid molecular testing, providing targeted support (e.g., financial subsidies, home-based care, and flexible treatment schedules) for high-risk workers, and implementing geriatric-adapted follow-up, and expanding active case finding, are urgently needed to protect this vulnerable population and to close this equity gap.
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