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Epidemiology of extrapulmonary tuberculosis among pediatric inpatients in mainland China: a descriptive, multicenter
Ping Chu1, Yan Chang1, Xuan Zhang1
1Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.
Insights
Pediatric extrapulmonary tuberculosis (EPTB) in China presents significant challenges, including higher mortality and financial burdens compared to pulmonary TB (PTB). Improved screening is crucial for early diagnosis and reduced costs.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Pediatric tuberculosis (TB) is a global health concern, often manifesting as extrapulmonary TB (EPTB) in children.
- The clinical, epidemiological, and economic impact of pediatric EPTB in China remains largely uncharacterized.
Purpose of the Study:
- To describe the clinical and epidemiological profile of pediatric EPTB in China.
- To assess the cost burden associated with pediatric EPTB compared to pulmonary TB (PTB).
Main Methods:
- A descriptive, multicenter study involving 4,654 pediatric TB patients across China (October 2015 - December 2018).
- Data collected on patient demographics, TB classification (PTB, EPTB, combined TB), hospitalization details, and financial impact.
Main Results:
- EPTB and combined TB cases showed longer hospital stays and higher discharge-against-medical-advice rates than PTB.
- Pediatric EPTB was linked to increased mortality, higher rates of low birth weight, delayed diagnosis, and greater financial burdens, including catastrophic expenditure.
- Meningitis TB was the most common EPTB form, incurring the highest costs.
Conclusions:
- Pediatric EPTB in China poses a substantial clinical and economic challenge.
- Current diagnostic approaches for pediatric EPTB require improvement to mitigate diagnostic delays and financial strain on families.
- Enhanced screening strategies are essential for better management of pediatric EPTB.
Abstract:
ABSTRACTPediatric tuberculosis (TB) is a serious infectious disease that affects many children worldwide and is more likely to be extrapulmonary than adult TB. However, the clinical and epidemiological profile, and cost burden of pediatric extrapulmonary TB (EPTB) in China remain unknown. Here, we conducted a descriptive, multicenter study of pediatric TB patients from 22 hospitals across all six regions in China from October 2015 to December 2018. Of 4,654 patients, 54.23% (2,524) had pulmonary TB (PTB), 17.76% (827) had EPTB, and 28.00% (1,303) had concurrent extrapulmonary and pulmonary TB (combined TB). Compared with PTB, EPTB and combined TB were associated with lower hospitalization frequency (2.43 and 2.21 vs. 3.16 times), longer length of stay (10.61 and 11.27 vs. 8.56 days), and higher rate of discharge against medical advice (8.46% and 9.44% vs. 5.67%). EPTB was associated with higher mortality (0.97% vs. 0.24% and 0.31%), higher rate of low birth weight (17.69% vs. 6.79% and 6.22%), worse diagnosis at the first visit (21.16% vs. 34.67% and 44.47%), and worse hospitalization plan situation (4.35% vs. 7.81% and 7.44%), compared with PTB and combined TB. EPTB and combined TB had higher financial burdens (17.67% and 16.94% vs. 13.30%) and higher rates of catastrophic expenditure (8.22% and 9.59% vs. 5.03%), compared with PTB. Meningitis TB (34.18%) was the most frequent form of total extrapulmonary infection and had the highest cost burden and rate of catastrophic expenditure. In conclusion, improved screening approaches for pediatric EPTB are needed to reduce diagnostic challenges and financial burden.
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