Financial Burden of Tuberculosis Patients - China, 2020.

What is already known about this topic?: Tuberculosis (TB) is often referred to as "a disease of poverty," yet the information regarding the financial burden of TB care is limited and regionally representative. What is added by this report?: This manuscript reported the national representative total and breakdown costs associated with TB care in China. The total cost per patient was 1,185 USD, of which 88% was direct cost and 37% was incurred prior to TB treatment. What are the implications for public health practice?: TB patients experience a significant financial burden, and disparities exist among different regions and populations. Current TB care policies and packages are not sufficient to address this issue.

Transition patterns of metabolism-weight phenotypes over time: A longitudinal study using the multistate Markov model in China.

Background: A change in weight or metabolic status is a dynamic process, yet most studies have focused on metabolically healthy obesity (MHO) and the transition between MHO and metabolically unhealthy obesity (MUO); therefore, they have not fully revealed the nature of all possible transitions among metabolism-weight phenotypes over the years. Methods: This was a longitudinal study based on a retrospective health check-up cohort. A total of 9,742 apparently healthy individuals aged 20-60 years at study entry were included and underwent at least two health check-ups. Six metabolism-weight phenotypes were cross-defined by body mass index (BMI) categories and metabolic status as follows: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), MHO, metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW), and MUO. A multistate Markov model was used to analyse all possible transitions among these phenotypes and assess the effects of demographic and blood indicators on the transitions. Results: The transition intensity from MUNW to MHNW was the highest (0.64), followed by the transition from MHO to MUO (0.56). The greatest sojourn time appeared in the MHNW state (3.84 years), followed by the MUO state (2.34 years), and the shortest sojourn time appeared in the MHO state (1.16 years). Transition intensities for metabolic improvement gradually decreased with BMI level as follows: 0.64 for MUNW to MHNW, 0.44 for MUOW to MHNW, and 0.27 for MUO to MHO; however, transition intensities for metabolic deterioration, including MHNW to MUNW, MHOW to MUOW, and MHO to MUO, were 0.15, 0.38, and 0.56, respectively. In the middle-aged male group, elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and uric acid (UA) increased the risk of deterioration in weight and metabolic status and decreased the possibility of improvement. Conclusion: Maintaining a normal and stable BMI is important for metabolic health. More attention should be given to males and elderly people to prevent their progression to an unhealthy metabolic and/or weight status. MHO is the most unstable phenotype and is prone to convert to the MUO state, and individuals with abnormal ALT, AST and UA are at an increased risk of transitioning to an unhealthy weight and/or metabolic status; therefore, we should be alert to abnormal indicators and MHO. Intervention measures should be taken early to maintain healthy weight and metabolic status.

Comparison of yield and relative costs of different screening algorithms for tuberculosis in active case-finding: a cross-section study.

BACKGROUND: Part of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China. METHODS: The study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms. RESULTS: Algorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p < 0.01, Kappa 95% CI: 0. 93-0.99) and China NTP (p = 0.03, Kappa 95% CI: 0.96-1.00). There was a significant difference in the total costs among different three algorithms WHO 1c/2/3 (F = 59.13, p < 0.01). No significant difference in the average costs for one active TB case screened and diagnosed through the process among Algorithms 1c/2/3 was evident (F = 2.78, p = 0.07). The average costs for one bacteriological positive case through algorithm WHO 1a was about two times as much as the costs for one active TB case through algorithms WHO 1c/2/3. CONCLUSIONS: Active case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding.

Transition Patterns of Weight Status and Their Predictive Lipid Markers Among Chinese Adults: A Longitudinal Cohort Study Using the Multistate Markov Model.

BACKGROUND: Obesity is well recognized as a risk factor for cardiometabolic diseases. The development of obesity is a dynamic process that can be described as a multistate process with an emphasis on transitions between weight states. However, it is still unclear what convenient biomarkers predict transitions between weight states. The aim of this study was to show the dynamic nature of weight status in adults stratified by age and sex and to explore blood markers of metabolic syndrome (MetS) that predict transitions between weight states. METHODS: This study involved 9795 individuals aged 18 to 56 at study entry who underwent at least two health check-ups in the eight-year period of study in the health check-up centre of our institution. Weight, height and biochemical indices were measured at each check-up. The participants were divided into four groups based on age and sex (young male, middle-aged male, young female and middle-aged female groups). A multistate Markov model containing 3 states (healthy weight, overweight and obesity) was adopted to study the longitudinal weight data. RESULTS: Young people were more likely to transit between weight states than middle-aged people, and middle-aged people were more resistant to recover from worse states. The mean sojourn time in obesity was greatest in the middle-aged male group (6.23 years), and the predicted rate of obesity beginning with healthy weight was greatest in the young male group (13.7%). In multivariate models, age group and triglyceride (TG) and high-density lipoprotein cholesterol (HDL) levels were significant for specific transitions in females, whereas age group and HDL levels were significant in males. In females, if HDL levels increased 1 mmol/L, the probability of progression from healthy weight to overweight decreased by 37.0% (HR= 0.63), and the probabilities of recovery (overweight to healthy weight and obesity to overweight) increased by 62.0% (HR= 1.62) and 1.23-fold (HR= 2.23), respectively. In males, if TG levels increased 1 mmol/L, the risk of progression from healthy weight to overweight increased by 24.0% (HR= 1.24). Each unit increase in HDL levels was associated with a 0.99-fold (HR= 1.99) increase in the chance of recovery from overweight to healthy weight and with a 0.37-fold (HR= 0.63) decrease in the risk of progression from healthy weight to overweight. CONCLUSION: The weight status of young people was less stable than that of middle-aged people. Males were more likely to become overweight and more resistant to recover from worse states than females. Young males with healthy weight were more likely to develop obesity than other healthy weight groups. Blood lipid levels, especially HDL, were predictors of weight transitions in adults. Prevention and intervention measures should be applied early.

Nutritional intakes and associated factors among tuberculosis patients: a cross-sectional study in China.

BACKGROUND: The objectives of this study were to examine nutrient intakes of tuberculosis (TB) patients and to identify their associated factors. METHODS: In this cross-sectional study, 300 adult TB patients were surveyed in two impoverished counties in China. Nutrient intakes were evaluated through two consecutive 24-h dietary recalls and compared with the Chinese Dietary Reference Intakes (DRIs) 2013. The potential socio-demographic and behavioral factors were analyzed using multivariate logistic model to identify strong influential factors. RESULTS: We found that mean daily energy intake was 1655.0 kcal (SD: 619.3 kcal) and 1360.3 kcal (SD: 552.1 kcal) for male and female patients, respectively. The mean daily energy intake was significantly lower than that has been recommended by DRI (i.e., 2250 and 1800 kcal for males and females, respectively), with 87.4% of the male patients and 59.9% of female patients failed to consume adequate energy. The protein intakes were 44.6 g (SD: 18.2 g) and 35.9 g (SD: 12.3 g) for male and female patients, respectively, which were lower than the recommended values by DRI (i.e., 65 and 55 g for males and females, respectively). Most male (90.8%) and female (58.4%) TB patients had insufficient daily protein intake. Further analyses suggested that mean daily intakes of many micronutrients, were insufficient, while for most of patients, intakes of vitamin E and sodium were sufficient. We identified that unemployment was a risk factor for low energy intake (p < 0.05) and out-home-eating was a protective factor for low protein intake (p < 0.01). CONCLUSIONS: In impoverished areas in China, intakes of macronutrients and most micronutrients in TB patients were inadequate compared with DRIs, especially for unemployed patients and patients eating at home. These findings suggested that public health actions are needed to promote education on TB patients about significance of nutritional support, and, further interventions in TB patients' nutritional intakes are also required.

Transition Patterns of Weight Status and Their Associated Factors among Elementary School Children: A Longitudinal Cohort Study Using Multistate Markov Model.

Background: Childhood obesity is a recognized public health concern worldwide. It is essential to study the natural progression of obesity in the interest of prevention. This study aimed to describe the dynamic changes in weight status among elementary school children and identify the significant factors influencing the progression or regression of weight status. Methods: This study involved 928 elementary school children who were followed up annually during their elementary school years. Heights, weights, and vital capacity (VC) were measured each school year. A multistate Markov model containing three weight states was fit to longitudinal weight status data. Results: Children with healthy weight and obesity tended to stay in their preceding weight state. Children with overweight, in contrast, were more likely to move to the other two states. The mean sojourn time in obesity and in overweight states was 5.15 years (95% confidence interval [CI]: 4.22-6.3) and 2 years (95% CI: 1.76-2.28), respectively. Children in lower grades, those with a lower VC index, those with a higher initial BMI, those with a higher annual weight increment, and boys were at increased risk of progression to overweight or obesity, with a decreased probability of regression. Conclusions: Children with obesity were more resistant to recovery than those with overweight. Prevention and intervention measures should be adopted early when abnormal weight onset occurs. The multistate Markov model was an advanced tool to analyze dynamic changes in status and identify significant factors for progression and regression and helped to develop prevention and intervention targeting strategies.

Comparing yield and relative costs of WHO TB screening algorithms in selected risk groups among people aged 65 years and over in China, 2013.

OBJECTIVE: To calculate the yield and cost per diagnosed tuberculosis (TB) case for three World Health Organization screening algorithms and one using the Chinese National TB program (NTP) TB suspect definitions, using data from a TB prevalence survey of people aged 65 years and over in China, 2013. METHODS: This was an analytic study using data from the above survey. Risk groups were defined and the prevalence of new TB cases in each group calculated. Costs of each screening component were used to give indicative costs per case detected. Yield, number needed to screen (NNS) and cost per case were used to assess the algorithms. FINDINGS: The prevalence survey identified 172 new TB cases in 34,250 participants. Prevalence varied greatly in different groups, from 131/100,000 to 4651/ 100,000. Two groups were chosen to compare the algorithms. The medium-risk group (living in a rural area: men, or previous TB case, or close contact or a BMI <18.5, or tobacco user) had appreciably higher cost per case (USD 221, 298 and 963) in the three algorithms than the high-risk group (all previous TB cases, all close contacts). (USD 72, 108 and 309) but detected two to four times more TB cases in the population. Using a Chest x-ray as the initial screening tool in the medium risk group cost the most (USD 963), and detected 67% of all the new cases. Using the NTP definition of TB suspects made little difference. CONCLUSIONS: To "End TB", many more TB cases have to be identified. Screening only the highest risk groups identified under 14% of the undetected cases,. To "End TB", medium risk groups will need to be screened. Using a CXR for initial screening results in a much higher yield, at what should be an acceptable cost.

Assessment of the safety and efficacy of an attenuated live vaccine based on highly pathogenic porcine reproductive and respiratory syndrome virus.

The safety and efficacy of the JXA1-R vaccine, an attenuated strain of highly pathogenic porcine reproductive and respiratory syndrome virus (HP-PRRSV), were examined using an intramuscular challenge model in piglets. The JXA1-R vaccine was obtained by passing HP-PRRSV JXA1 through Marc-145 cells (82nd passage). Genomic sequence comparisons showed that strain JXA1-R and its parental strain, JXA1, differ by 47 amino acids, and most of these differences are scattered throughout the PRRSV genome. Four-week-old PRRSV-free piglets were inoculated intramuscularly with JXA1-R vaccine (10(3.0), 10(4.0), 10(5.0), 10(6.0), and 10(7.0) 50% tissue culture infective doses [TCID50]/ml for groups 1 to 5, respectively) and then challenged intramuscularly with the 5th passage virus of JXA1 virus (JXA1-F5, 3 ml × 10(4.5) TCID50/ml) 28 days after inoculation. The humoral immune response, swine growth, clinical signs, and differential organ lesions were monitored. The results showed that all vaccinated piglets had a perceptible humoral immune response to vaccination after day 7, which then promptly increased, almost reaching the maximum sample/positive (S/P) ratio value at 28 days postimmunization. Viremia detection indicated that the viral replication levels of the challenge virus in the immunized groups (immunization doses ≥10(4.0)/ml) were significantly lower than that of the virus-challenged unvaccinated control group. Piglets in groups 2 to 5 were effectively protected against lethal HP-PRRSV infection and did not show any obvious changes in body temperature or clinical signs of disease at any point during the experiment. However, two of five piglets in group 1 showed mild pathological lesions and transitory high fever. These results suggest that JXA1-R (TCID50/ml ≥10(4.0)) is sufficiently attenuated and can provide effective protection against the lethal wild-type HP-PRRSV.