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Multicenter Study
. 2022 Dec;11(1):1090-1102.
doi: 10.1080/22221751.2022.2054367.

Epidemiology of extrapulmonary tuberculosis among pediatric inpatients in mainland China: a descriptive, multicenter study

Ping Chu  1 , Yan Chang  1 , Xuan Zhang  1 , Shujing Han  1 , Yaqiong Jin  1 , Yongbo Yu  1 , Yeran Yang  1 , Guoshuang Feng  2 , Xinyu Wang  2 , Ying Shen  3 , Xin Ni  1   4 , Yongli Guo  1 , Jie Lu  1 ; Futang Research Center of and Pediatric Development (FRCPD)  1
Affiliations
Multicenter Study

Epidemiology of extrapulmonary tuberculosis among pediatric inpatients in mainland China: a descriptive, multicenter study

Ping Chu et al. Emerg Microbes Infect. 2022 Dec.

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.

Keywords: China; Extrapulmonary tuberculosis; children; epidemiology; inpatients.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Distribution of participating hospitals comprising provincial (orange colour) and municipal hospitals (blue colour).
Figure 2.
Figure 2.
Distribution of pediatric TB cases among hospitals in our study.
Figure 3.
Figure 3.
EPTB disease sites among 2,130 pediatric patients in China, 2015–2018.
Figure 4.
Figure 4.
Age distributions of PTB and forms of EPTB in China, 2015–2018.
Figure 5.
Figure 5.
Hospitalization expenses among 4,654 pediatric patients in China, 2015–2018. A) Total hospitalization expenses of PTB and forms of EPTB. B) Out-of-pocket hospitalization expenses of PTB and forms of EPTB. C) Cost burdens of PTB and forms of EPTB. D) Catastrophic expenditures of PTB and forms of EPTB.
Figure 6.
Figure 6.
Expenses of PTB and forms of EPTB in China, 2015–2018.
See this image and copyright information in PMC

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