{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:04:48Z","timestamp":1789538688840,"version":"build-2803163510"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The rising global burden of multidrug- and rifampicin-resistant tuberculosis (MDR\/RR-TB) coincides with rapid population aging. Older patients face unique challenges, yet age-stratified analyses of the MDR\/RR-TB care cascade are lacking, obscuring the specific barriers they encounter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to characterize the treatment cascade and identify factors associated with attrition among older MDR\/RR-TB patients in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 667 MDR\/RR-TB patients aged \u226565\u202fyears in Guangdong Province, southern China (2010\u20132022). Using data from the national Tuberculosis Information Management System (TIMS), we constructed a care cascade to quantify attrition across four stages (diagnosis, treatment initiation, retention at 6\u202fmonths, and treatment success) and three inter-stage gaps (attrition between successive stages). Separate multivariable logistic regression models identified factors associated with failure to initiate treatment and with poor outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 667 diagnosed patients (median age 70), 500 (74.96%) initiated treatment, 406 (60.87% of diagnosed cases, 81.2% of treated cases) were retained at 6\u202fmonths, and only 268 (40.18% of diagnosed cases, 53.6% of treated cases) achieved treatment success. Multivariable analysis showed that workers\/farmers (\n                      <jats:italic>a<\/jats:italic>\n                      OR\u202f=\u202f1.87, 95% CI: 1.24\u20132.84), diagnosis by conventional DST (\n                      <jats:italic>a<\/jats:italic>\n                      OR\u202f=\u202f9.34, 95% CI: 4.52\u201321.64), diagnosis before 2016 (\n                      <jats:italic>a<\/jats:italic>\n                      OR\u202f=\u202f1.91, 95% CI: 1.18\u20133.08), and older age (\n                      <jats:italic>a<\/jats:italic>\n                      OR\u202f=\u202f1.05 per year, 95% CI: 1.01\u20131.08) were independently associated with failure to initiate treatment; prior TB treatment history was protective (\n                      <jats:italic>a<\/jats:italic>\n                      OR\u202f=\u202f0.42, 95% CI: 0.25\u20130.72). Among treatment initiators, older age (\n                      <jats:italic>a<\/jats:italic>\n                      OR\u202f=\u202f1.06 per year, 95% CI: 1.02\u20131.09) and diagnosis before 2016 (\n                      <jats:italic>a<\/jats:italic>\n                      OR\u202f=\u202f1.88, 95% CI: 1.06\u20133.39) were independent risk factors for poor outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The MDR\/RR-TB care cascade for older patients in China is marked by severe pre-treatment attrition. Targeted interventions, including scaling up rapid molecular testing, providing targeted support (e.g., financial subsidies, home-based care, and flexible treatment schedules) for high-risk workers, and implementing geriatric-adapted follow-up, and expanding active case finding, are urgently needed to protect this vulnerable population and to close this equity gap.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1883068","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:31:58Z","timestamp":1789536718000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe pre-treatment attrition in the care cascade: clinical outcomes and risk factors among older MDR\/RR-TB patients in China"],"prefix":"10.3389","volume":"14","author":[{"given":"Fangjing","family":"Zhou","sequence":"first","affiliation":[{"name":"Public Health Medical Center of Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Huang","sequence":"additional","affiliation":[{"name":"Public Health Medical Center of Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiying","family":"Feng","sequence":"additional","affiliation":[{"name":"Public Health Medical Center of Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianwei","family":"Li","sequence":"additional","affiliation":[{"name":"Public Health Medical Center of Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huizhong","family":"Wu","sequence":"additional","affiliation":[{"name":"Public Health Medical Center of Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhui","family":"Chen","sequence":"additional","affiliation":[{"name":"Public Health Medical Center of Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenpei","family":"Wen","sequence":"additional","affiliation":[{"name":"Public Health Medical Center of Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lebin","family":"Liu","sequence":"additional","affiliation":[{"name":"Public Health Medical Center of Guangdong Province","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref1","volume-title":"Global Tuberculosis Report 2025","year":"2025"},{"key":"ref2","volume-title":"The End TB 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