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Shao Y, Song W, Song H, Li G, Zhu L, Liu Q, Chen C. Incidence, Outcomes, and Risk Factors for Isoniazid-Resistant Tuberculosis from 2012 to 2022 in Eastern China. Antibiotics (Basel) 2024; 13:378. [PMID: 38667054 PMCID: PMC11047343 DOI: 10.3390/antibiotics13040378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/01/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Isoniazid-resistant, rifampicin-susceptible tuberculosis (Hr-TB) is the most frequent drug-resistant tuberculosis (DR-TB) in the world, and unfavorable outcomes of Hr-TB are more common compared to drug-susceptible TB. Considering there is no optimal regimen accepted worldwide, we undertook a retrospective cohort study in eastern China to estimate incidence trends and risk factors associated with unfavorable outcomes of Hr-TB. METHODS Between January 2012 and December 2022, all Hr-TB patients' information was extracted from the Tuberculosis Information Management System (TIMS), which is a national electronic information platform, to record TB patients' clinical information in this study. The incidence of Hr-TB was determined by the mid-year population according to census data published by the government. We categorized treatment regimens depending on fluoroquinolone (FQ) use, and potential risk factors were analyzed using multivariable logistic regression. RESULTS A total of 3116 Hr-TB patients fulfilled the inclusion criteria and were enrolled in this study. The average annual rate of Hr-TB in the 11 years under investigation was 0.34 per 100,000 and increased to 0.53 per 100,000 until 2019. In total, six different treatment regimens were utilized in the study sites, and less than 1% of regimens adopted FQ. There was no difference in the unfavorable outcomes between the FQ-included and FQ-excluded groups (p = 0.22). The average treatment duration was 7.06 months, and the longest treatment was 26 months. Approximately 20% (637/3116) of Hr-TB patients had unfavorable outcomes, and 60.13% (383/637) of them proceeded to multidrug-resistant tuberculosis (MDR-TB). Treatment duration and a positive smear at the end of the 5th month were significantly associated with unfavorable outcomes (p < 0.001). CONCLUSION The unfavorable treatment outcomes of Hr-TB are still high in eastern China, and the efficacy of FQ-containing regimens needs to be validated for Hr-TB treatment.
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Affiliation(s)
- Yan Shao
- Center for Disease Control and Prevention of Jiangsu Province, Department of Chronic Communicable Disease, Nanjing 210009, China; (Y.S.); (H.S.); (G.L.); (L.Z.); (Q.L.)
| | - Wenlei Song
- Center for Disease Control and Prevention of Kunshan, Suzhou 215300, China;
| | - Honghuan Song
- Center for Disease Control and Prevention of Jiangsu Province, Department of Chronic Communicable Disease, Nanjing 210009, China; (Y.S.); (H.S.); (G.L.); (L.Z.); (Q.L.)
| | - Guoli Li
- Center for Disease Control and Prevention of Jiangsu Province, Department of Chronic Communicable Disease, Nanjing 210009, China; (Y.S.); (H.S.); (G.L.); (L.Z.); (Q.L.)
| | - Limei Zhu
- Center for Disease Control and Prevention of Jiangsu Province, Department of Chronic Communicable Disease, Nanjing 210009, China; (Y.S.); (H.S.); (G.L.); (L.Z.); (Q.L.)
| | - Qiao Liu
- Center for Disease Control and Prevention of Jiangsu Province, Department of Chronic Communicable Disease, Nanjing 210009, China; (Y.S.); (H.S.); (G.L.); (L.Z.); (Q.L.)
| | - Cheng Chen
- Center for Disease Control and Prevention of Jiangsu Province, Department of Chronic Communicable Disease, Nanjing 210009, China; (Y.S.); (H.S.); (G.L.); (L.Z.); (Q.L.)
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Timire C, Houben RMGJ, Pedrazzoli D, Ferrand RA, Calderwood CJ, Bond V, Mbiba F, Kranzer K. Higher loss of livelihood and impoverishment in households affected by tuberculosis compared to non-tuberculosis affected households in Zimbabwe: a cross-sectional study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299470. [PMID: 38106129 PMCID: PMC10723493 DOI: 10.1101/2023.12.05.23299470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Introduction Tuberculosis (TB) disproportionally affects poor people, leading to income and non-income losses. Measures of socioeconomic impact of TB, e.g. impoverishment and patient costs are inadequate to capture non-income losses. We applied impoverishment and a multidimensional measure on TB and non-TB affected households in Zimbabwe. Methods We conducted a cross-sectional study in 270 households: 90 non-TB; 90 drug-susceptible TB (DS-TB), 90 drug-resistant TB (DR-TB) during the COVID-19 pandemic (2020-2021). Household data included ownership of assets, number of household members, income and indicators on five capital assets: financial, human, social, natural and physical. We determined proportions of impoverished households for periods 12 months prior and at the time of the interview. Households with incomes below US$1.90/day were considered to be impoverished. We used principal component analysis on five capital asset indicators to create a binary outcome variable indicating loss of livelihood. Log-binomial regression was used to determine associations between loss of livelihood and type of household. Results TB-affected households reported higher previous episodes of TB and household members requiring care than non-TB households. Households that were impoverished 12 months prior to the study were: 21 non-TB (23%); 40 DS-TB (45%); 37 DR-TB (41%). The proportions increased to 81%, 88% and 94%, respectively by the time of interview. Overall, 56% (152/270) of households sold assets: 44% (40/90) non-TB, 58% (52/90) DS-TB and 67% (60/90) DR-TB. Children's education was affected in 31% (56/180) of TB-affected compared to 13% (12/90) non-TB households. Overall, 133(50%) households experienced loss of livelihood, with TB-affected households twice as likely to experience loss of livelihood; adjusted prevalence ratio (aPR=2.02 (95%CI:1.35-3.03)). The effect of TB on livelihood was most pronounced in poorest households (aPR=2.64, (95%CI:1.29-5.41)). Conclusions TB-affected households experienced greater socioeconomic losses compared to non-TB households. Multidimensional measures of TB are crucial to inform multisectoral approaches to mitigate impacts of TB and other shocks.
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Affiliation(s)
- Collins Timire
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
- The Health Research Unit, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Rein MGJ Houben
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK
| | - Debora Pedrazzoli
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK
| | - Rashida Abbas Ferrand
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Claire J Calderwood
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy London School of Hygiene &Tropical Medicine, London, UK
- Social Sciences Unit, Zambart, Lusaka, Zambia
| | - Fredrick Mbiba
- The Health Research Unit, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Katharina Kranzer
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit, Biomedical Research & Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich
- German Center for Infection Research (DZIF), Munich
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Zhou M, Peng Y, Liu K, Zhou L, Wang F, Chen X, Chen B, Hu C. Direct Medical Expenses and Influencing Factors of MDR/RR-TB in Eastern China: Based on Data from Multi-Hospital Information Systems. Risk Manag Healthc Policy 2023; 16:1955-1965. [PMID: 37753096 PMCID: PMC10518261 DOI: 10.2147/rmhp.s420082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/02/2023] [Indexed: 09/28/2023] Open
Abstract
Background Multidrug-resistant (MDR) and rifampicin-resistant (RR) tuberculosis (TB) is related to high healthcare costs. However, studies on direct healthcare expenditure in different settings remain inconclusive. Hence, we aimed to examine the direct medical expenses (DME) of patients with MDR/RR-TB and assessed which patient characteristics were associated with higher costs. Methods DME was evaluated using records from the hospital information system in three cities with different economic levels in Zhejiang Province, Eastern China, matching with data (including socio-demographics, disease treatment status, etc.) collected in the Tuberculosis Management Information System. A logistic regression model was used to identify variables associated with higher costs. Results Of 193 patients with MDR/RR-TB, the average DME was $10,491 (interquartile range (IQR) $4679-16,710), consisting of $2696 (IQR $1019-5100) out-of-pocket costs, medical reimbursement, and subsidies, accounting for 32%, 50.3% and 14%, respectively. A total of 74.2% and 56% of DME were for drugs and anti-TB drugs, respectively. Only 16.9% of the patients were treated with an all-oral regimen. Higher DME was significantly associated with local residents 7.29 (95% confidence interval (CI) [2.62-20.3]), hospitalization experience 7.63 (95% (CI) [2.54-22.95]), longer duration of treatment 6.63 (95% CI [2.27-19.35]), and lower health insurance reimbursement 5.65 (95% CI [1.90-16.79]). Conclusion DME of patients with MDR/RR-TB was still significant, and domestic migrants, hospitalization, long treatment duration, and high health insurance rates increased the financial burden on MDR/RR-TB patients. Reasonable intervention programs should be developed to reduce the medical burden of patients with MDR/RR-TB, according to the DME and its component of MDR-TB patients, besides the economic status of their regions.
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Affiliation(s)
- Meng Zhou
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Ying Peng
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Lin Zhou
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Fei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Xinyi Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Bin Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Chonggao Hu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
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Liu K, Zhang M, Luo D, Zheng Y, Shen Z, Chen B, Jiang J. Influencing Factors of Treatment Outcomes Among Patients with Pulmonary Tuberculosis: A Structural Equation Model Approach. Psychol Res Behav Manag 2023; 16:2989-2999. [PMID: 37559781 PMCID: PMC10408682 DOI: 10.2147/prbm.s419906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Pulmonary tuberculosis (PTB) is a serious infectious disease, and the factors and pathways that influence final treatment outcomes are unclear. Here, we aimed to assess the factors that influence treatment outcomes in patients with PTB using a structural equation model. METHODS Participants completed a questionnaire covering demographics, understanding of PTB, psychological status, and history of medical treatment. Exploratory factor analysis and reliability testing were performed, and a structural equation model was constructed using the SPSS and Amos software. RESULTS A total of 251 participants were enrolled. Symptoms of depression were observed in 94.4% of participants, whereas 6% showed mild or greater anxiety. Through factor rotation, four common factors were extracted with a total variation of 66.15%. The structural equation model indicated that regular tuberculosis-related follow-up behaviour had a direct and positive effect on the final treatment outcome, with a path coefficient value of 0.20; the level of PTB understanding had a direct positive effect on the testing behaviour for PTB, with a path coefficient of 0.26; patients' psychological characteristics had a direct negative impact on regular testing behaviour, with a path coefficient of -0.13. The psychological characteristics and level of disease understanding of patients exerted indirect effects on the treatment outcome by affecting the way patients approached tuberculosis detection behaviour. CONCLUSION Interventions aimed at improving the treatment outcomes of patients with PTB should mainly focus on financial support and improvements in psychological status in addition to a greater understanding and knowledge of PTB. Furthermore, patients should be encouraged to undergo regular PTB testing during the follow up period, as this mediates the effect of other factors on treatment outcomes and also helps in achieving favourable treatment outcomes.
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Affiliation(s)
- Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Mengdie Zhang
- Department of Social Medicine of School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Dan Luo
- Department of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yan Zheng
- Department of Tuberculosis Control and Prevention, Fenghua Center for Disease Control and Prevention, Ningbo, Zhejiang Province, People’s Republic of China
| | - Zhenye Shen
- Department of Tuberculosis Control and Prevention, Fenghua Center for Disease Control and Prevention, Ningbo, Zhejiang Province, People’s Republic of China
| | - Bin Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Jianmin Jiang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People’s Republic of China
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Xia L, Gao L, Zhong Y, Wu Y, He J, Zou F, Jian R, Xia S, Chen C, Zhu S. Assessing the influencing factors of out-of-pocket costs on tuberculosis in Sichuan Province: a cross-sectional study. BMC Public Health 2023; 23:1391. [PMID: 37468877 DOI: 10.1186/s12889-023-16180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Although diagnosis and treatment services for tuberculosis (TB) are provided free of charge in most countries, direct non-medical and indirect costs due to absenteeism, also place a significant burden on patients and their families. Sichuan Province has the second highest incidence of TB in China, with an incidence of approximately 100 cases per 100 000 people. However, there are limited research on out-of-pocket expenditure (OOPE) and its influencing factors in TB patients in Sichuan Province. METHODS A retrospective cross-sectional study was conducted on TB patients in designated medical institutions for TB in Sichuan Province from 2017-2021. A face-to-face questionnaire was conducted to obtain the information related to hospitalization of patients, and the multi-level regression model was used to analyse the factors that influence OOPE and total out-of-pocket expenditure (TOOPE) of TB patients. RESULTS A total of 2644 patients were investigated, and 74.24% of TB patients and their families experienced catastrophic total costs due to TB. The median total cost was 9223.37 CNY (1429.98 USD), in which the median direct and indirect costs of TB patients were 10185.00 CNY (1579.07 USD) and 2400.00 CNY (372.09 USD), respectively, and indirect costs contributed to 43% of total costs. The median OOPE and TOOPE costs were 6024.00 CNY (933.95 USD) and 11890.50 CNY (1843.49 USD), respectively. OOPE and TOOPE had common influencing factors including whether the patient's family had four or more members, a history of hospitalization, combination with other types of TB, the number of visits before diagnosis, and co-occurrence with chronic disease. CONCLUSIONS The OOPE and TOOPE for TB patients and their families in Sichuan Province are still heavy. In the long run, it is necessary to strengthen education and awareness campaigns on TB related knowledge, disseminate basic medical knowledge to the public, improve healthcare-seeking behavior, and enhance the healthcare infrastructure to improve the accuracy of TB diagnosis and reduce the significant OOPE and TOOPE faced by TB patients and their families in Sichuan Province.
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Affiliation(s)
- Lan Xia
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Lijie Gao
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Yin Zhong
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Ya Wu
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Jinge He
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Fengjuan Zou
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Ronghua Jian
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Sujian Xia
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Chuang Chen
- Department of Tuberculosis, Sichuan Provincial Center for Disease Control and Prevention, No.6 Middle School Road, Wuhou District, Chengdu, 610041, Sichuan Province, China.
| | - Sui Zhu
- Department of Epidemiology and Statistics, School of Medicine, Jinan University, Guangzhou, 510632, China.
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Jing C, Zheng H, Wang X, Wang Y, Zhao Y, Liu S, Zhao J, Du Q. Disease burden of tuberculosis and post-tuberculosis in Inner Mongolia, China, 2016-2018 - based on the disease burden of post-TB caused by COPD. BMC Infect Dis 2023; 23:406. [PMID: 37316793 DOI: 10.1186/s12879-023-08375-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains one of the most serious infectious diseases worldwide. China has the second highest TB burden globally, but existing studies have mostly neglected the post-tuberculosis (post-TB) disease burden. This study estimated the disease burden of TB and post-TB in Inner Mongolia, China, from 2016 to 2018. METHODS Population data were collected from TB Information Management System. Post-TB disease burden was defined as the burden caused by Chronic Obstructive Pulmonary Disease (COPD) occurring after patients with TB were cured. To estimate the incidence rate of TB, standardized mortality rate, life expectancy, and cause eliminated life expectancy, using descriptive epidemiological, abridged life table and cause eliminated life table. On this basis, the Disability-Adjusted Life Years (DALY), Years Lived with Disability (YLD) and Years of Life Lost (YLL) due to TB were further be estimated. The data were analyzed using Excel 2016 and SPSS 26.0. Joinpoint regression models were used to estimate the time and age trends of the disease burden of TB and post-TB. RESULTS The TB incidence in 2016, 2017, and 2018 was 41.65, 44.30, and 55.63/100,000, respectively. The standardized mortality in the same period was 0.58, 0.65, and 1.08/100,000, respectively. From 2016 to 2018, the total DALYs of TB and post-TB were 5923.33, 6258.03, and 8194.38 person-years, and the DALYs of post-TB from 2016 to 2018 were 1555.89, 1663.33, and 2042.43 person-years. Joinpoint regression showed that the DALYs rate increased yearly from 2016 to 2018, and the rate of males was higher than that of females. TB and post-TB DALYs rates showed a rising tendency with increasing age (AAPC values were 149.6% and 157.0%, respectively, P < 0.05), which was higher in the working-age population and elderly. CONCLUSION The disease burden of TB and post-TB was heavy and increased year by year in Inner Mongolia from 2016 to 2018. Compared with the youngster and females, working-age population and the elderly and males had a higher disease burden. Policymakers should be paid more attention to the patients' sustained lung injury after TB cured. There is a pressing need to identify more effective measures for reducing the burden of TB and post-TB of people, to improve their health and well-being.
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Affiliation(s)
- Caimei Jing
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Jinshan Development District, Hohhot, Inner Mongolia, 010110, China
| | - Huiqiu Zheng
- Department of Child and Adolescent Health and Health Education, School of Public Health, Inner Mongolia Medical University, Hohhot, Inner Mongolia, 010110, China
| | - Xuemei Wang
- Center for Data Science in Health and Medicine, School of Public Health, Inner Mongolia Medical University, Jinshan Development District, Hohhot, Inner Mongolia, 010110, China.
| | - Yanling Wang
- Department of Child and Adolescent Health and Health Education, School of Public Health, Inner Mongolia Medical University, Hohhot, Inner Mongolia, 010110, China
| | - Yifan Zhao
- Center for Data Science in Health and Medicine, School of Public Health, Inner Mongolia Medical University, Jinshan Development District, Hohhot, Inner Mongolia, 010110, China
| | - Sijia Liu
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Jinshan Development District, Hohhot, Inner Mongolia, 010110, China
| | - Jing Zhao
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Jinshan Development District, Hohhot, Inner Mongolia, 010110, China
| | - Qianqian Du
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Jinshan Development District, Hohhot, Inner Mongolia, 010110, China
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Maresca G, Latella D, Carnazza L, Corallo F, Formica C. Neuropsychological effects of COVID-19: A review. Brain Behav 2022; 12:e2602. [PMID: 35903894 PMCID: PMC9353421 DOI: 10.1002/brb3.2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/03/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The purpose of this review is to examine review literature on the psychological effects of the COVID-19 pandemic. METHODS Studies were identified by an online search of the PubMed database. We selected studies published from January to May 2020 (during the COVID-19 emergency). RESULTS We found that psychological effects of COVID-19 remain serious among the most of the population, in particular for people with mental disorders, adolescents, healthcare workers, and the general population that experienced high levels of stress, anxiety, and depression symptoms, with possible long-term psychological implications. CONCLUSION Findings revealed that living in urban areas, having economic stability, and living with parents were protective factors against anxiety for youth groups, whereas a risk factor was represented by the presence of COVID-19 infection that involved family members.
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Affiliation(s)
| | | | - Lara Carnazza
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
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Yang DL, Li W, Pan MH, Su HX, Li YN, Tang MY, Song XK. Spatial analysis and influencing factors of pulmonary tuberculosis among students in Nanning, during 2012–2018. PLoS One 2022; 17:e0268472. [PMID: 35609085 PMCID: PMC9129035 DOI: 10.1371/journal.pone.0268472] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Economically underdeveloped areas in western China are hotspots of tuberculosis, especially among students. However, the related spatial and temporal patterns and influencing factors are still unclear and there are few studies to analyze the causes of pulmonary tuberculosis in students from the perspective of space.
Methods
We collected data regarding the reported incidence of pulmonary tuberculosis (PTB) among students at township level in Nanning, from 2012 to 2018. The reported incidence of pulmonary tuberculosis among students in Nanning was analyzed using spatial autocorrelation and spatial scan statistical analysis to depict hotspots of PTB incidence and spatial and temporal clustering. Spatial panel data of the reported incidence rates and influencing factors at district and county levels in Nanning were collected from 2015 to 2018. Then, we analyzed the spatial effects of incidence and influencing factors using the spatial Durbin model to explore the mechanism of each influencing factor in areas with high disease prevalence under spatial effects.
Results
From 2012 to 2018, 1609 cases of PTB were reported among students in Nanning, with an average annual reported incidence rate of 14.84/100,000. Through the Joinpoint regression model, We observed a steady trend in the percentage of cases reported each year (P>0.05). There was spatial autocorrelation between the annual reported incidence and the seven-years average reported incidence from 2012 to 2018. The high-incidence area was distributed in the junction of six urban areas and spread to the periphery, with the junction at the center. The population of college students, per capita financial expenditure on health, per capita gross domestic product, and the number of health technicians per 1,000 population were all influencing factors in the reported incidence of PTB among students.
Conclusion
We identified spatial clustering of the reported incidence of PTB among students in Nanning, mainly located in the urban center and its surrounding areas. The clustering gradually decreased from the urban center to the surrounding areas. Spatial effects influenced the reported incidence of PTB. The population density of college students, per capita health financial expenditure, gross domestic product (GDP) per capita, and the number of health technicians per 1,000 were all influencing factors in the reported incidence of PTB among students.
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Affiliation(s)
- Dan-ling Yang
- Department of Health Statistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Wen Li
- Department of Health Statistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Meng-hua Pan
- School of Information and Management, Guangxi Medical University, Nanning, Guangxi, China
| | - Hai-xia Su
- Department of Health Statistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yan-ning Li
- Department of Health Statistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- * E-mail:
| | - Meng-ying Tang
- Department of Health Statistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-kun Song
- Department of Health Statistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
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Li J, Ouyang J, Yuan J, Li T, Luo M, Wang J, Chen Y. Establishment and evaluation of an overlap extension polymerase chain reaction technique for rapid and efficient detection of drug-resistance in Mycobacterium tuberculosis. Infect Dis Poverty 2022; 11:31. [PMID: 35321759 PMCID: PMC8942611 DOI: 10.1186/s40249-022-00953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid and accurate detection of drug resistance in Mycobacterium tuberculosis is critical for effective control of tuberculosis (TB). Herein, we established a novel, low cost strategy having high accuracy and speed for the detection of M. tuberculosis drug resistance, using gene splicing by overlap extension PCR (SOE PCR). METHODS The SOE PCR assay and Sanger sequencing are designed and constructed to detect mutations of rpoB, embB, katG, and inhA promoter, which have been considered as the major contributors to rifampicin (RFP), isoniazid (INH), and ethambutol (EMB) resistance in M. tuberculosis. One hundred and eight M. tuberculosis isolates came from mycobacterial cultures of TB cases at Chongqing Public Health Medical Center in China from December 2018 to April 2019, of which 56 isolates were tested with the GeneXpert MTB/RIF assay. Performance evaluation of the SOE PCR technique was compared with traditional mycobacterial culture and drug susceptibility testing (DST) or GeneXpert MTB/RIF among these isolates. Kappa identity test was used to analyze the consistency of the different diagnostic methods. RESULTS We found that the mutations of S531L, S315T and M306V were most prevalent for RFP, INH and EMB resistance, respectively, in the 108 M. tuberculosis isolates. Compared with phenotypic DST, the sensitivity and specificity of the SOE PCR assay for resistance detection were 100.00% and 88.00% for RFP, 94.64% and 94.23% for INH, and 68.97% and 79.75% for EMB, respectively. Compared with the GeneXpert MTB/RIF, the SOE PCR method was completely consistent with results of the GeneXpert MTB/RIF, with a concordance of 100% for resistance to RFP. CONCLUSIONS In present study, a novel SOE PCR diagnostic method was successfully developed for the accurate detection of M. tuberculosis drug resistance. Our results using this method have a high consistency with that of traditional phenotypic DST or GeneXpert MTB/RIF, and SOE PCR testing in clinical isolates can also be conducted rapidly and simultaneously for detection of drug resistance to RFP, EMB, and INH.
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Affiliation(s)
- Jungang Li
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing Ouyang
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing Yuan
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Shapingba District, 109 Baoyu Road, Chongqing, 400036, China
| | - Tongxin Li
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Ming Luo
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing Wang
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Yaokai Chen
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China. .,Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China. .,Division of Infectious Diseases, Chongqing Public Health Medical Center, Shapingba District, 109 Baoyu Road, Chongqing, 400036, China.
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10
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Setoodehzadeh F, Barfar E, Ansari H, Sari AA, Azizi N. The economic burden of tuberculosis in Sistan: a high-risk region in Iran. Trop Med Int Health 2021; 26:649-655. [PMID: 33668078 DOI: 10.1111/tmi.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To estimate the economic burden of tuberculosis treatment in Sistan, the region with the highest number of tuberculosis cases in Iran. METHODS All patients with smear-positive pulmonary tuberculosis who had contracted tuberculosis in 2018 and successfully completed their treatment were interviewed. RESULTS Ninety patients with a mean age of 57 ± 18 years were interviewed. Most of them were women (58%), housewives (57%) and resided in rural areas (84%). The mean cost of treatment for tuberculosis was estimated as 6800 USD per patient. Direct costs were 87% of the total cost. Twenty-two patients lost an average income of 530 USD (8514590 rials) during treatment. The results showed the significant correlation of direct and indirect costs with sex, age, place of residence and education (P < 0.05). CONCLUSION It appears essential to improve social protection and implement interventions to promote knowledge in rural areas.
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Affiliation(s)
- Fatemeh Setoodehzadeh
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Eshagh Barfar
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hossein Ansari
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Azizi
- Master of Health Care Management, Zahedan University of Medical Sciences, Zahedan, Iran
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11
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Zhang L, Weng TP, Wang HY, Sun F, Liu YY, Lin K, Zhou Z, Chen YY, Li YG, Chen JW, Han LJ, Liu HM, Huang FL, Cai C, Yu HY, Tang W, Huang ZH, Wang LZ, Bao L, Ren PF, Deng GF, Lv JN, Pu YL, Xia F, Li T, Deng Q, He GQ, Li Y, Zhang WH. Patient pathway analysis of tuberculosis diagnostic delay: a multicentre retrospective cohort study in China. Clin Microbiol Infect 2021; 27:1000-1006. [PMID: 33421578 DOI: 10.1016/j.cmi.2020.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/13/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Delay in diagnosis of tuberculosis (TB) is an important but under-appreciated problem. Our study aimed to analyse the patient pathway and possible risk factors of long diagnostic delay (LDD). METHODS We enrolled 400 new bacteriologically diagnosed patients with pulmonary TB from 20 hospitals across China. LDD was defined as an interval between the initial care visit and the confirmation of diagnosis exceeding 14 days. Its potential risk factors were investigated by multivariate logistic regression and multilevel logistic regression. Hospitals in China were classified by increasing size, from level 0 to level 3. TB laboratory equipment in hospitals was also evaluated. RESULTS The median diagnostic delay was 20 days (IQR: 7-72 days), and 229 of 400 patients (57.3%, 95%CI 52.4-62.1) had LDD; 15% of participants were diagnosed at the initial care visit. Compared to level 0 facilities, choosing level 2 (OR 0.27, 95%CI 0.12-0.62, p 0.002) and level 3 facilities (OR 0.34, 95%CI 0.14-0.84, p 0.019) for the initial care visit was independently associated with shorter LDD. Equipping with smear, culture, and Xpert at initial care visit simultaneously also helped to avoid LDD (OR 0.28, 95%CI 0.09-0.82, p 0.020). The multilevel logistic regression yielded similar results. Availability of smear, culture, and Xpert was lower in level 0-1 facilities than in level 2-3 facilities (p < 0.001, respectively). CONCLUSIONS Most patients failed to be diagnosed at the initial care visit. Patients who went to low-level facilities initially had a higher risk of LDD. Improvement of TB laboratory equipment, especially at low-level facilities, is urgently needed.
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Affiliation(s)
- Lu Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Tao-Ping Weng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong-Yu Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Sun
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan-Yuan Liu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Ke Lin
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhe Zhou
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan-Yuan Chen
- Department of Tuberculosis, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yong-Guo Li
- Department of Infectious Diseases, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Ji-Wang Chen
- Department of Tuberculosis, The Second Hospital of Daqing, Daqing, China
| | - Li-Jun Han
- Department of Tuberculosis, Changchun Hospital of Infectious Diseases, Changchun, China
| | - Hui-Mei Liu
- Department of Tuberculosis, Xuzhou Hospital of Infectious Diseases, Xuzhou, China
| | - Fu-Li Huang
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cui Cai
- Department of Tuberculosis, Guiyang Public Health Clinical Centre, Guiyang, China
| | - Hong-Ying Yu
- Department of Infectious Diseases, The First People's Hospital of Huaihua, Huaihua, China
| | - Wei Tang
- Provincial Key Laboratory for Respiratory Infectious Diseases in Shandong, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zheng-Hui Huang
- Department of Tuberculosis, Wuhan Jin Yin-Tan Hospital, Wuhan, China
| | - Long-Zhi Wang
- Department of Tuberculosis Xi'an Chest Hospital, Xi'an, China
| | - Lei Bao
- Department of Infectious Diseases, Anhui Provincial Hospital, Anhui, China
| | - Peng-Fei Ren
- Department of Tuberculosis, Henan Province Infectious Diseases Hospital, Zhengzhou, China
| | - Guo-Fang Deng
- Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital (The Second Affiliated Hospital of Shenzhen University), Shenzhen University School of Medicine, Shenzhen, China
| | - Jian-Nan Lv
- Department of Tuberculosis, Beihai Tuberculosis Hospital, Beihai, China
| | - Yong-Lan Pu
- Department of Infectious Diseases, The First People's Hospital of Taicang, Taicang, China
| | - Fan Xia
- Department of Infectious Diseases, 905th Military Hospital, Naval Medical University, Shanghai, China
| | - Tao Li
- Department of Infectious Diseases, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China
| | - Qun Deng
- Department of Tuberculosis, Jiangxi Chest Hospital, Jiangxi, China
| | - Gui-Qing He
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, China
| | - Yang Li
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
| | - Wen-Hong Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
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12
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Du L, Xu J, Chen X, Zhu X, Zhang Y, Wu R, Ji H, Zhou L. Rebuild doctor-patient trust in medical service delivery in China. Sci Rep 2020; 10:21956. [PMID: 33319841 PMCID: PMC7738514 DOI: 10.1038/s41598-020-78921-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/24/2020] [Indexed: 12/30/2022] Open
Abstract
Doctor–patient trust is not strong in China, but studies examining this factor remain insufficient. The present study aimed to explore the effect of doctor–patient communication, medical service quality, and service satisfaction on patient trust in doctors. Five hundred sixty-four patients with tuberculosis participated in this cross-sectional study in Dalian, China. They completed questionnaires assessing socio-demographic characteristics, doctor–patient communication, medical service quality, service satisfaction and patient trust in medical staff. A structural equation model was applied to examine the hypotheses, and all the study hypotheses were supported: (1) doctor–patient communication, medical service quality and service satisfaction were positively associated with building doctor–patient trust; (2) service quality positively mediated the relationship between doctor–patient communication and trust; (3) medical service satisfaction positively mediated the relationship between doctor–patient communication and trust; (4) medical service satisfaction positively mediated the relationship between medical service quality and doctor–patient trust; and (5) medical service quality and service satisfaction were the positively sequential mediators between communication and doctor–patient trust. Based on these findings, improvements in doctor–patient communication, medical service quality, and service satisfaction are the important issues contributing to the rebuilding of doctor–patient trust in medical service delivery.
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Affiliation(s)
- Liang Du
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China
| | - Jia Xu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China
| | - Xu Chen
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China
| | - Xuexue Zhu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China
| | - Yu Zhang
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China.
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13
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He WC, Ju K, Gao YM, Zhang P, Zhang YX, Jiang Y, Liao WB. Spatial inequality, characteristics of internal migration, and pulmonary tuberculosis in China, 2011-2017: a spatial analysis. Infect Dis Poverty 2020; 9:159. [PMID: 33213525 PMCID: PMC7678065 DOI: 10.1186/s40249-020-00778-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/11/2020] [Indexed: 12/26/2022] Open
Abstract
Background Human migration facilitate the spread of tuberculosis (TB). Migrants face an increased risk of TB infection. In this study, we aim to explore the spatial inequity of sputum smear-positive pulmonary TB (SS + PTB) in China; and the spatial heterogeneity between SS + PTB and internal migration. Methods Notified SS + PTB cases in 31 provinces in mainland China were obtained from the national web-based PTB surveillance system database. Internal migrant data were extracted from the report on China’s migrant population development. Spatial autocorrelations were explored using the global Moran’s statistic and local indicators of spatial association. The spatial variation in temporal trends was performed using Kulldorff’s scan statistic. Fixed effect and spatial autoregressive models were used to explore the spatial inequity between SS + PTB and internal migration. Results A total of 2 380 233 SS + PTB cases were reported in China between 2011 and 2017, of which, 1 716 382 (72.11%) were male and 663 851 (27.89%) were female. Over 70% of internal migrants were from rural households and had lower income and less education. The spatial variation in temporal trend results showed that there was an 9.9% average annual decrease in the notification rate of SS + PTB from 2011 to 2017; and spatial clustering of SS + PTB cases was mainly located in western and southern China. The spatial autocorrelation results revealed spatial clustering of internal migration each year (2011–2017), and the clusters were stable within most provinces. Internal emigration, urban-to-rural migration and GDP per capita were significantly associated with SS + PTB, further, internal emigration could explain more variation in SS + PTB in the eastern region in mainland. However, internal immigration and rural-to-urban migration were not significantly associated with SS + PTB across China. Conclusions Our study found the spatial inequity between SS + PTB and internal migration. Internal emigration, urban-to-rural migration and GDP per capita were statistically associated with SS + PTB; the negative association was identified between internal emigration, urban-to-rural migration and SS + PTB. Further, we found those migrants with lower income and less education, and most of them were from rural households. These findings can help stakeholders to implement effective PTB control strategies for areas at high risk of PTB and those with high rates of internal migration.
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Affiliation(s)
- Wen-Chong He
- Research Management Office, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Ke Ju
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Ya-Min Gao
- Department of Health, Northwest Minzu University, Lanzhou, China
| | - Pei Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Yin-Xia Zhang
- Department of Health, Northwest Minzu University, Lanzhou, China
| | - Ye Jiang
- School of Geography and Environmental Engineering, Lanzhou City University, Lanzhou, China
| | - Wei-Bin Liao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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14
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Anser MK, Yousaf Z, Khan MA, Nassani AA, Alotaibi SM, Qazi Abro MM, Vo XV, Zaman K. Does communicable diseases (including COVID-19) may increase global poverty risk? A cloud on the horizon. ENVIRONMENTAL RESEARCH 2020; 187:109668. [PMID: 32422482 PMCID: PMC7228701 DOI: 10.1016/j.envres.2020.109668] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 05/11/2023]
Abstract
Coronavirus epidemic can push millions of people in poverty. The shortage of healthcare resources, lack of sanitation, and population compactness leads to an increase in communicable diseases, which may increase millions of people add in a vicious cycle of poverty. The study used the number of factors that affect poverty incidence in a panel of 76 countries for a period of 2010-2019. The dynamic panel GMM estimates show that the causes of death by communicable diseases, chemical-induced carbon and fossil fuel combustion, and lack of access to basic hand washing facilities menace to increase poverty headcounts, whereas, an increase in healthcare expenditures substantially decreases poverty headcounts across countries. Further, the results show the U-shaped relationship between economic growth and poverty headcounts, as economic growth first decreases and later increase poverty headcount due to rising healthcare disparities among nations. The causality estimates show that lack of access to basic amenities lead to increase of communicable diseases including COVID-19 whereas chemical-induced carbon and fossil fuel emissions continue to increase healthcare expenditures and economic growth in a panel of selected countries. The rising healthcare disparities, regional conflicts, and public debt burden further 'hold in the hand' of communicable diseases that push millions of people in the poverty trap.
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Affiliation(s)
- Muhammad Khalid Anser
- Department of Public Administration, Xi'an University of Architecture and Technology, Xi'an, 710000, China
| | - Zahid Yousaf
- Higher Education Department Khyber Pakhtunkhwa, Government College of Management Sciences, Abbottabad, 22060, Pakistan
| | - Muhammad Azhar Khan
- Department of Economics, University of Haripur, Khyber Pakhtunkhwa, Haripur, Pakistan
| | - Abdelmohsen A Nassani
- Department of Management, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh, 11587, Saudi Arabia
| | - Saad M Alotaibi
- Department of Management, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh, 11587, Saudi Arabia
| | - Muhammad Moinuddin Qazi Abro
- Department of Management, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh, 11587, Saudi Arabia
| | - Xuan Vinh Vo
- Institute of Business Research and CFVG Ho Chi Minh City, University of Economics Ho Chi Minh City, 59C Nguyen Dinh Chieu Street, District 3, Ho Chi Minh City, Viet Nam
| | - Khalid Zaman
- Institute of Business Research, University of Economics Ho Chi Minh City, 59C Nguyen Dinh Chieu Street, District 3, Ho Chi Minh City, Viet Nam; Department of Economics, University of Wah, Quaid Avenue, Wah Cantt, Pakistan.
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