Epidemiology of drug-resistant tuberculosis in Hunan China over a 10-year period

Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in China, yet long-term epidemiological data from key regions such as Hunan Province in South-Central China are still limited.

This study aimed to characterize the epidemiological trends, spatial distribution, and risk factors of Single drug-resistant tuberculosis (SDR-TB), poly-drug-resistant tuberculosis (PDR-TB), multidrug-resistant tuberculosis (MDR-TB), rifampicin-resistant tuberculosis (RR-TB), and isoniazid-resistant tuberculosis (INH-R TB) in Hunan Province between 2014 and 2023, to inform region-specific control strategies.

It was a retrospective analysis that was conducted on 6,597 laboratory-confirmed DR-TB cases. Data were obtained from the Provincial Tuberculosis Control Institute. All patients underwent phenotypic drug susceptibility testing. Independent risk factors for DR-TB subtypes were identified through multivariable logistic regression, with adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) calculated.

A total of 6,597 patients with DR-TB were included in this 10-year analysis. Among them, 74.97% were male and 64.44% were farmers. The highest case burden was observed in the 50-59 age group (24.78%). Spatially, cases clustered mainly in the Changsha (16.39%), Shaoyang (13.78%), and Loudi (9.05%). The most common resistance subtypes were INH-R TB (56.27%) and MDR-TB (52.37%). The distribution of all DR-TB subtypes varied significantly across age groups (p < 0.05), with peaks in middle-aged and older adults. Over time, the detection rate of MDR-TB was highest in 2018, while RR-TB remained the most frequently detected resistance type. Multivariable analysis identified significant regional and demographic disparities. The eastern region of Hunan was associated with an increased risk of SDR-TB (OR = 1.334) and PDR-TB (OR = 1.208), whereas the western region carried the highest risk for MDR-TB (OR = 1.734). Female patients consistently showed lower risks of MDR-TB (OR = 0.819) and RR-TB (OR = 0.784) compared with males.

This study presents a 10-year epidemiological assessment of DR-TB in Hunan Province, China, covering 2014-2023. A disproportionately high burden was observed among middle-aged and older male farmers. The predominance of INH-R TB and MDR-TB, together with distinct regional and demographic risk profiles, underscores an urgent need to strengthen TB control measures. These results support the implementation of targeted interventions, including intensified screening in high-risk populations and in high-incidence areas, along with optimized treatment regimens, to curb the ongoing DR-TB epidemic in South-Central China.