Factors associated with unfavorable outcomes in rifampicin-susceptible pulmonary tuberculosis cases aged 18-65 years in Suzhou, Jiangsu, 2019−2023: a retrospective cohort study

Objective To analyze the epidemiological characteristics of unfavorable treatment outcomes in rifampicin-sensitive pulmonary tuberculosis (TB) patients aged 18−65 years in Suzhou, Jiangsu province, identify influencing factors, and provide evidence to reduce the incidence of unfavorable outcomes of rifampicin-sensitive pulmonary TB patients in this age group.

Methods Data were extracted from the Tuberculosis Management System of the China Disease Control and Prevention Information System for a retrospective cohort analysis to understand the epidemiological characteristics of unfavorable treatment outcomes in rifampicin-sensitive pulmonary TB patients aged 18−65 years, and Cox proportional hazards model was constructed to identify factors associated with treatment outcomes.

Results During the period from January 2019 to June 2023, among the pulmonary tuberculosis cases aged 18-65 years in Suzhou city, there were 6 365 male cases (68.05%) and 2 989 female cases (31.95%), respectively. The proportion of those with unfavorable treatment outcomes was 4.75%. Significant differences were observed in age between the unfavorable outcome group and the favorable outcome group (41.90 ± 13.66 vs. 38.21 ± 13.24 years, P<0.001). Multivariate Cox proportional hazards model analysis revealed that retreatment hazard ratio (HR)=2.37 95%CI: 1.78–3.14, non-standard treatment regimen (HR=1.42, 95%CI: 1.15–1.75), older age (HR=1.01, 95%CI: 1.00–1.02), self-medication (HR=9.82, 95%CI: 7.10–13.57), positive etiological results (HR=3.54, 95% CI: 2.62–4.78), and urban residence (HR=1.32, 95%CI: 1.05–1.64) were significant factors associated with unfavorable treatment outcomes in pulmonary TB patients aged 18−65 years in Suzhou.

Conclusion During the study period, the rate of favorable treatment outcome in pulmonary TB patients aged 18−65 years was 95.25% in Suzhou, slightly higher than the average successful treatment rate (2022) for newly diagnosed and relapsed pulmonary TB patients in China in 2022. However, challenges still exist in TB prevention and treatment due to factors such as suboptimal treatment management, non-standardized regimens, patients' residential environment, and older age. It is necessary to conduct targeted interventions in the pulmonary TB patients affected by these risk factors to improve the clinical treatment outcomes.