Investigation of catastrophic health expenditure of pulmonary tuberculosis patients and influencing factors in Guiyang, Guizhou, 2021−2022

Objective To evaluate the incidence of catastrophic health expenditure of pulmonary tuberculosis (TB) patients and influencing factors in Guiyang, Guizhou province, and provide suggestions and evidence for reducing the economic burden of pulmonary TB patients.

Methods A retrospective survey was conducted by using the data from questionnaire survey and hospital information system, and the rate of catastrophic health expenditure was described. The influencing factors were analyzed by χ² and Log-binomial regression.

Results The average total payment for the treatment of pulmonary TB in 471 patients in Guiyang was 8201.00 yuan (3900.02, 14809.33). Up to 53.72% (49.22%−58.22%) of the patients had catastrophic health expenditure. Multivariate analysis showed that the patients with high annual income (≥18000 yuan) had low risk for catastrophic health expenditure prevalence ratio (PR)=0.78, 95% confidence interval (CI): 0.66–0.93. Diagnosis delay (PR=1.17, 95%CI: 1.02–1.35), the first visit to non-TB designated hospital (PR=1.21, 95%CI=1.04–1.40), multiple hospital visits (≥3) (PR=1.42, 95%CI: 1.16–1.74) and multiple hospitalizations (≥2 ) (PR=2.37, 95%CI: 1.86–3.04) were the risk factors for catastrophic health expenditure. The results of stratified analysis showed that ≥2 times of hospitalization was a common risk factor for both urban and rural patients in different occupation and age groups, and medical insurance was a unique protective factor for rural patients.

Conclusion The incidence of catastrophic health expenditure in pulmonary TB patients was relatively high in Guiyang, and it is necessary to further strengthen the social security and health education for the patients with low annual income, delayed diagnosis, the first visit to non-designated hospital, and multiple hospital visits and hospitalizations. For the rural patients, it is necessary to take integrated measures, including medical insurance and others, and conduct active screening for the early detection, diagnosis and treatment of pulmonary TB patients to reduce the economic burden and reduce catastrophic health expenditure of the patients.