Time and spatial distribution of multidrug-resistant tuberculosis among Chinese people, 1981-2006: a systematic review

Objectives: We aimed to investigate trends in the prevalence of multidrug-resistant tuberculosis (MDR-TB) among Chinese people from first report to 2006, and to detect the high prevalence regions in order to guide control efforts.

Materials and methods: The CBM, VIP, CNKI, and MEDLINE databases were searched through both keywords and subject headings. The literature was screened, and two investigators assessed the quality and extracted the data. Trends in MDR-TB prevalence in three groups--primary, acquired, and combined MDR-TB--were examined separately, using the Cochran-Armitage trend test. Differences were tested with the Kruskal-Wallis test. High prevalence provinces were explored through comparison of the 95% confidence interval (95% CI) with the national average level.

Results: Overall 169 studies were included, with 165 in Chinese and four in English. One hundred and sixteen studies concerned primary MDR-TB, 103 acquired MDR-TB, and 130 combined MDR-TB, with total positive Mycobacterium tuberculosis (MTB) isolates of 110 076, 25 187, and 150 233, respectively. The prevalences of MDR-TB in the three groups in 2005 were 2.64-, 6.20-, and 3.84-times that of 1985, respectively, all showing an upward trend (p<0.05). The prevalences among the three groups were significantly different (p<0.05), with acquired drug resistance (27.5%, 95% CI 26.9-28.1%) much higher than primary drug resistance (4.3%, 95% CI 4.2-4.4%), and combined resistance (9.9%, 95% CI 9.8-10.1%) in between. The top three prevalence regions for primary, acquired, and combined MDR-TB were distributed in the zone from the northeast to the southwest of China, with Hebei, Tibet, and Shanxi having an extremely high prevalence.

Conclusions: The prevalence of MDR-TB among the Chinese people has shown an upward trend since 1985. It is necessary to continue to monitor this trend in China. Special attention should be paid to provinces distributed in the zone from the northeast to the southwest of China for MDR-TB surveillance, research, and control.