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Free Content Poverty and the economic effects of TB in rural China

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OBJECTIVE: To investigate the economic effects of illness on individual tuberculosis (TB) cases in rural China and to use a case-control study to show a strong TB-poverty link.

SETTING: In 2002–2004 we studied 160 new smear-positive pulmonary tuberculosis (PTB) cases and 320 age- and sex-matched controls living in neighbouring houses in four rural counties of Henan Province.

DESIGN: Cases and controls were interviewed 1–3 months after patients were diagnosed. We used matched multivariate logistic regression to compare cases with controls for poverty status using household income, household assets and relative wealth within the village. We conducted follow-up interviews of patients 10–12 months later to assess economic effects by collecting data on treatment costs, income losses, coping strategies and treatment completion.

RESULTS: Poverty is strongly associated with TB incidence even after controlling for smoking and other risk factors. Excluding income losses, direct out-of-pocket treatment costs (medical and non-medical) accounted for 55.5% of average annual household income, and most TB cases fell into heavy debt. The DOTS cure rate was 91%. When DOTS was incomplete or not done, mortality was high.

CONCLUSIONS: Poverty is both a cause and a devastating outcome of TB. Ongoing poverty reduction schemes in China must also include reducing TB.
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Keywords: China; DOTS; cost of illness; economics; poverty; tuberculosis

Document Type: Regular Paper

Affiliations: 1: School of Economics, The University of Queensland, Brisbane, Queensland, Australia 2: National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia 3: The Henan Centre for Disease Prevention and Control, Zhengzhou, Henan Province, China

Publication date: 2006-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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