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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2013, Vol. 7 Issue (3) : 354-366     DOI: 10.1007/s11684-013-0257-3
RESEARCH ARTICLE |
Treatment outcomes of pulmonary tuberculosis in the past decade in the mainland of China: a meta-analysis
Xiangwei Li1, Yu Yang1, Jianmin Liu2, Feng Zhou1, Wei Cui2, Ling Guan2, Fei Shen2, Cong Gao1, Mufei Li1, Qi Jin1(), Lei Gao1()
1. MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100176, China; 2. Henan Provincial Hospital of Infectious Diseases, Zhengzhou 450015, China
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Abstract  

Due to the implementation of directly observed treatment strategy (DOTS), China has made a significant achievement in tackling the tuberculosis (TB) epidemic in the 1990s. However, only half of regions in China met or exceeded the 85% rate of treatment success target. The aim of the present study is to summarize the treatment outcomes of smear-positive pulmonary TB in the mainland of China in the past decade using meta-analysis based on systematic review of published observational studies. A total of 50 eligible articles (58 studies) were identified and included in this study. The summarized treatment success rates were 93.9% (95% CI, 92.8%–94.7%) for new cases and 85.4% (95% CI, 83.0%–87.6%) for previously treated cases, and the summarized cured rate were 92.2% (95% CI, 90.9%–93.3%) and 81.2% (95% CI, 79.1%–83.1%), respectively. A remarkable increase of rates for treatment success and cure was observed in the 1990s. After 2000, the summarized treatment outcomes were tending towards stability. In addition, geographic areas, type of the data and administrative level of the hospital were also found to influence the estimates of the treatment outcomes. Results of the present study clearly show, in general, that the pulmonary TB treatment achieved significant success in the past decade in the mainland of China. However, it needs to be further strengthened in the central and west areas.

Keywords tuberculosis      treatment      outcome      China      meta-analysis     
Corresponding Authors: Jin Qi,Email:jinqi@ipbcams.ac.cn; Gao Lei,Email:gaolei@ipbcams.ac.cn   
Issue Date: 05 September 2013
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-013-0257-3     OR     http://academic.hep.com.cn/fmd/EN/Y2013/V7/I3/354
Fig.1  Flow diagram of study search and identification.
Fig.2  Time trend of pulmonary tuberculosis treatment effect in the mainland of China (1992-2007). The treatment success and cured rates were summarized yearly by meta-analysis, between 1992 and 2007, for new cases and previously treated cases, respectively. Please refer to Tables 5 and 6 for original data.
First author, published yearEnrollment timeRegionStudy levelPatients’ sourceStudy basePercentage of males (%)Mean age/age range (year)Type of patients
Feng SF, 1997[6]1992-1995SichuanCounty levelRPPopulation based64.79ALLNew cases
Xu WG, 1998[7]1996-1997JiangsuCounty levelRPHospital basedNANAMixed
Huang SL, 1999[8]1993-1996GuangdongMixedRPPopulation based75.61ALLNew cases
Liu FJ, 2000[9]1992-1998HainanMixedR&TPopulation basedNANAMixed
Shen BG, 2001[10]1985-1989BeijingCounty levelRPPopulation basedNANANew cases
Chen W, 2001[11]1998-1999FujianCity levelRPMixedNANANew cases
Fu YJ, 2001[12]1992-1995HainanMixedRPPopulation based67.716-78Previously treated cases
Jiang HX, 2001[13]1994-1999ZhejiangMixedRPPopulation basedNANAMixed
Chen QY, 2003[14]1999-2002FujianCounty levelRPHospital basedNANAMixed
Zeng YF, 2003[15]1992-2001HainanCounty levelRPPopulation based74.1AllMixed
Zhang M, 2003[16]1992-2001GuangdongMixedRPHospital based73.715-75Mixed
Deng CJ, 2004[17]1995-2001SichuanCity levelRPPopulation basedNANANew cases
Zhou HH, 2004[18]1992-2001GuangdongMixedRPMixed64.7AllMixed
Wang ZF, 2004[19]1993-2001ShandongCity levelRPHospital based74.553.9Previously treated cases
Peng JM, 2004[20]1992-2001GuangdongMixedRPMixedNANAMixed
Lei M, 2005[21]1993-2000HubeiMixedRPMixedNANAMixed
Li Z, 2005[22]1992-2001GuangdongMixedRPMixedNANAMixed
Yang FL, 2005[23]1993-2002XinjiangCity levelRPPopulation basedNANAMixed
Qiu GL, 2005[24]1993-2001GuangdongMixedR&TMixedNANANew cases
Yu RS, 2005[25]1992-2002GuangdongCity levelRPPopulation basedNANAMixed
Liu QF, 2005[26]1995-2002YunnanMixedRPMixedNANAMixed
Chen LP, 2005[27]1997-2003HubeiCity levelRPHospital basedNANAMixed
Guo HC, 2006[28]1992-2001GuangdongCity levelRPPopulation basedNANAMixed
Li ZM, 2006[29]1993-2003GuangdongCity levelRPHospital basedNANAPreviously treated cases
Pan HQ, 2006[30]2001-2004JiangsuCity levelRPPopulation basedNANAMixed
Zhao YK, 2008[31]2001-2006HenanCounty levelRPPopulation basedNANAMixed
Tab.1  Characteristics of the included studies (Part 1/2)
First author, published yearEnrollment timeRegionStudy basePatient sourceData sourcePercentage of males (%)Mean age/age range (year)Type of patients
Wan JY, 2008[32]2001-2005HunanMixedRPMixed68.83NAMixed
Zhang SL, 2008a[33]2002-2006ZhejiangMixedR&TMixed64.03NANew cases
Zhang SL, 2008b[33]2002-2006ZhejiangMixedR&TMixed64.91NANew cases
Jiang H, 2008[34]2003-2005GuizhouCounty levelRPPopulation based70.9NAMixed
Xu L, 2008[35]2005YunnanMixedRPMixed66.637New cases
Wang ZM, 2008[36]2002-2005HubeiMixedRPMixedNANAMixed
Zeng XX, 2008[37]2003-2006HunanCounty levelRPHospital based73.85NAMixed
Yang NZ, 2008[38]2002-2005ZhejiangCity levelRPPopulation based69.57NAMixed
Wang L, 2008[39]2002-205ZhejiangCity levelRPMixed66.44NAMixed
Xu H, 2009[40]2007HebeiCity levelRPMixed68.4142.5(M)/39(F)New cases
Zhu ZG, 2009[41]2003-2007JiangsuCounty levelRPPopulation basedNANAMixed
Yue YH, 2009[42]2002-2006SichuanCity levelRPPopulation basedNANAMixed
Zhao YL, 2009[43]2004-2007GuangxiCounty levelRPPopulation basedNANANew cases
Yang FL, 2005 [44]2002-2006XinjiangCity levelRPMixedNANAMixed
Yu FL, 2009[45]1994-2007HunanCounty levelRPPopulation based73.2#/84.27*AllMixed
Liao W, 2010[46]2003-2008SichuanCity levelR&TPopulation basedNANAMixed
Guo JZ, 2010[47]2003-2009FujianCity levelRPPopulation basedNANANew cases
Wang J, 2010[48]2006-2007BeijingCity levelRPPopulation based77.117-88Previously treated cases
Ding SH, 2011[49]2001-2009JiangsuMixedRPMixed72.8ALLMixed
Amiya M, 2011[50]2003-2008XinjiangMixedRPMixedNANAMixed
Yi LL, 2006[51]2002-2004GuangdongCity levelRPPopulation basedNANAMixed
Wei P, 2007[52]2003-2005ShanxiMixedRPMixedNANANew cases
Lin DW, 2007[53]2003-2004GuangxiCity levelRPHospital basedNANAMixed
Wu JL, 2007[54]2002-2005GuizhouMixedRPMixedNANAMixed
Liu CY, 2007[55]2001-2005HunanCounty levelRPPopulation based65.79NAMixed
Tab.2  Characteristics of the included studies (Part 2/2)
First author, published yearNumber of new casesNumber of re-treatment cases
CRTotalCuredFailedDiedCompletedDefaulted2nd month3rdmonthCRTotalCuredFailedDiedCompletedDefaulted2nd month3rdmonth
Feng SF, 1997[6]g19 50117 97703153461 17817 96218 639NANANANANANANANANA
Xu WG, 1998[7]b36234133123NANAk1811160172523NANA
Huang SL, 1999[8]f1 9821 742514265821 4441 668NANANANANANANANANA
Liu FJ, 2000p[9]d or f7617151141817NANAi or k2251599133311NANA
Liu FJ, 2000q[9]d or f154119801710NANAi or k1180030NANA
Shen BG, 2001[10]b or h4734070183117NANANANANANANANANANANA
Shen BG, 2001m[10]b or h25923101585NANANANANANANANANANANA
Shen BG, 2001n[10]b or h24322601232NANANANANANANANANANANA
Chen W, 2001p[11]d or f2 0491 6801332819217NANANANANANANANANANANA
Chen W, 2001q[11]d or f2 2972 056912128122NANANANANANANANANANANA
Jiang HX, 2001[13]e608555411247NANAi or k1088351217NANA
Fu YJ, 2001[12]NANANANANANANANANAj331258016570247NA
Chen QY, 2003[14]b1 0631 0330253271 0631 033j290255216314249273
Zeng YF, 2003[15]d or f2 2412 11602027982 2412 116i or k314258010937235254
Zhang M, 2003[16]d or f4 3204 15061344267NANAi or k68559725211725560613
Deng CJ, 2004[17]b111210270183928NANANANANANANANANANANA
Wang ZF, 2004[19]NANANANANANANANANAj1411271814132133
Zhou HH, 2004[18]d or f6 2746 03611550151085 6845 804i or k1 4231 10612124491239891 068
Peng JM, 2004[20]d or f5 9195 8130632086NANAi or k1 6031 4901453829NANA
Lei M, 2005[21]b or d9 5749 2221012545181NANAk3 3522 8043862125116NANA
Li Z, 2005[22]d or f6 5106 2492311833876 0056 319i or k1 5151 312235464621 1881 331
Yang FL, 2005[23,56]d or f6175980766552592i or k1431270466113127
Qiu GL, 2005p[24]d or f6166033628565592NANANANANANANANANA
Qiu GL, 2005q[24]d or f1 7991 73915110351 6421 742NANANANANANANANANA
Tab.3  Treatment outcomes of patients with smear-positive pulmonary tuberculosis in the included studies (Part 1/3)
First author,published yearNumber of new casesNumber of previously treated cases
CRTotalCuredFailedDiedCompletedDefaulted2nd month3rdmonthCRTotalCuredFailedDiedCompletedDefaulted2nd month3rdmonth
Yu RS, 2005[25]b or d3 3563 2857193529NANAk6545443127916NANA
Liu QF, 2005[26]d or f53540260111954417441i or k22413341141818150174
Chen LP, 2005[27]b1341250009NANANANANANANANANANANA
Guo HC, 2006[28]d or f3 2293 16303725412 9563 172NA726613037733519635
Pan HQ, 2006[30]d or f178150651210139160i or k987547845876
Yi LL, 2006[51]d or f1 5341 44901520651 4471 497i or k12510708100NANA
Li ZM, 2006[29]NANANANANANANANANAj550465483NA34478505
Wu JL, 2007[54]b4 1333 41719297694553 1123 268j1 9861 54810654622161 3801 580
Liu CY, 2007[55]d or f8587536911521NANAi or k13110552712NANA
Zhao YK, 2008[31]d or f1 0991 00316391130NANAir k39831821211919NANA
Wan Jiayin, 2008[32]d or f5 5205 152101749184NANAi or k2 0911 675466455251NANA
Zhang SL, 2008p[33]d or f2 4182 094263861199NANANANANANANANANANANA
Zhang SL, 2008q[33]d or f1 2421 0536153390NANANANANANANANANANANA
Jiang H, 2008[34]d or f268204317818219240i or k675673015560
Xu L, 2008[35]b4 6543 95621311783285NANANANANANANANANANANA
Wang ZM, 2008[36]d or f6 7616 3992172510110NANAi or k1 011891867621NANA
Zeng XX, 2008[37]b1 3951 262412/622701 3111 365j273231151/1720243265
Yang NZ, 2008[38]b44639717/22226385399j836002/01476172
Wang L, 2008p[39]d or f3 7143 24506639475NANAi or k8646440591538NANA
Wang L, 2008q[39]d or f8917140562115NANAi or k12489011024NANA
Xu H, 2009[40]b956875153/111553 9014 267NANANANANANANANANA
Zhu ZG, 2009[41]d or f7186751014429664NAd or f107756515666NA
Yue YH, 2009[42]d or f250205254515192207d or f9260166196672
Tab.4  Treatment outcomes of smear-positive pulmonary tuberculosis reported by the included studies (Part 2/3)
First author,published yearNumber of new casesNumber of previously treated cases
CRTotalCuredFailedDiedCompletedDefaulted2nd month3rdmonthCRTotalCuredFailedDiedCompletedDefaulted2nd month3rdmonth
Zhao YL, 2009[43]d or f7777234211337NANANANANANANANANANANA
Yang FL, 2005[44]d or f33932105135302328i or k100900433NANA
Yu FL, 2009[45]d or f3 1812 9432951781312 8473 035i or k229184812169198211
Liao W, 2010[46]d or f587557110118NANAi or k1691581217NANA
Guo JZ, 2010p[47]d or f15713508319NANANANANANANANANANANA
Guo JZ, 2010q[47]d or f1151090015NANANANANANANANANANANA
Wang J, 2010[48]NANANANANANANANANAi17012935294NANA
Ding SH, 2011[49]d or f11 85910 94566172141535NANAi or k2 0521 5685388131212NANA
Amiya M, 2011[50]d or f1 9681 75978170114NANAi or k5364374710141NANA
Tab.5  Treatment outcomes of smear-positive pulmonary tuberculosis reported by the included studies (Part 3/3)
Number of included studiesSummarized rate95% CIP for Q testI-square (%)Begg rank correlation analysisEgger weighted regression analysis
New casesCured540.9220.909, 0.933<0.0198.3800.6720.312
Successfully treated540.9390.928, 0.947<0.0197.9540.5760.081
Failed540.0140.011, 0.019<0.0197.3030.9350.002
Died540.0130.011, 0.016<0.0188.5060.1420.074
Completed540.0130.010, 0.016<0.0196.0640.3350.016
2nd month230.8850.858, 0.908<0.0198.8640.1780.913
3rd month220.9460.925, 0.962<0.0199.0650.9780.182
Previously treated cases
Cured390.8120.791, 0.831<0.0192.5780.7800.824
Successfully treated390.8540.830, 0.876<0.0195.1880.3770.568
Failed380.0490.036, 0.065<0.0195.1080.1710.068
Died390.0350.028, 0.043<0.0184.0560.1300.450
Completed390.0320.024, 0.043<0.0192.8030.3040.010
2nd month200.7800.746, 0.811<0.0192.2140.2990.048
3rd month180.8760.845, 0.901<0.0193.3950.3440.010
Tab.6  Summarized pulmonary tuberculosis treatment outcomes in the mainland of China
Number of studiesSummarized cured rateSummarized success rate
Summarized rate95% CIP for Q testI-square (%)Summarized rate95% CIP for Q testI-square (%)
Stratified analysis of new cases
Stratified by levels of hospitalCounty level140.9090.884, 0.930<0.0197.4480.9280.912, 0.941<0.0194.362
City level200.9200.890, 0.942<0.0198.3470.9360.912, 0.954<0.0197.949
Mixed200.9330.913, 0.948<0.0198.7070.9470.930, 0.960<0.0198.489
Stratified by databasePopulation based250.9190.903, 0.933<0.0195.9860.9340.921, 0.944<0.0194.115
Mixed230.9180.894, 0.937<0.0199.0960.9390.920, 0.954<0.0198.910
Hospital based60.9470.920, 0.965<0.0193.5170.9560.934, 0.971<0.0191.487
Stratified by geographic areas*East China340.9270.909, 0.942<0.0198.3320.9390.923, 0.951<0.0198.035
Central China90.9230.899, 0.941<0.0196.3000.9450.926, 0.959<0.0195.502
West China110.9060.872, 0.931<0.0198.7750.9330.911, 0.949<0.0197.920
Stratified analysis of previously treated cases
Stratified by levels of hospitalCounty level90.7990.749, 0.841<0.0183.8550.8380.782, 0.882<0.0188.332
City level160.8190.784, 0.849<0.0185.1860.8440.807, 0.875<0.0188.204
Mixed140.8120.776, 0.844<0.0196.3740.8720.832, 0.903<0.0197.630
Stratified by databasePopulation based200.8030.774, 0.829<0.0177.3410.8290.806, 0.850<0.0168.258
Mixed120.807,0.768, 0.840<0.0196.8980.8690.824, 0.904<0.0198.156
Hospital based70.8410.785, 0.885<0.0190.1330.8760.802, 0.911<0.0194.334
Stratified by geographic areas*East China240.8070.776, 0.835<0.0193.3670.8290.797, 0.857<0.0193.853
Central China70.8280.801, 0.852<0.0183.6840.8970.825, 0.942<0.0197.878
West China80.8150.746, 0.868<0.0192.4780.8770.836, 0.909<0.0183.714
Tab.7  Summarized pulmonary tuberculosis treatment success and cured rate in the mainland of China
YearNumber of studiesSuccess rate95% CICure rate95% CIFailed rate95% CINumber of studies2nd month95% CI3rd month95% CI
199260.8920.814, 0.9400.8240.692, 0.9070.0440.019, 0.10540.5520.252, 0.8180.750.464, 0.912
1993120.9000.861, 0.9290.8640.808, 0.9050.0350.021, 0.05870.7770.644, 0.8700.8940.806, 0.944
1994130.9340.919, 0.9460.9240.919, 0.9280.0180.012, 0.02680.8290.725, 0.8990.940.872, 0.973
1995140.9490.924, 0.9660.9390.909, 0.9600.0130.007, 0.02590.8420.739, 0.9090.9250.835, 0.968
1996140.9640.950, 0.9740.9570.940, 0.9690.0100.006, 0.01780.8720.807, 0.9180.9410.893, 0.968
1997140.9710.951, 0.9830.9640.942, 0.9780.0080.004, 0.02070.9370.901, 0.9610.9810.936, 0.994
1998140.9740.959, 0.9830.9670.943, 0.9810.0090.004, 0.01870.9410.904, 0.9640.9750.944, 0.989
1999130.9750.960, 0.9840.9670.950, 0.9780.0070.004, 0.01280.9350.881, 0.9650.9680.894, 0.991
2000130.9810.969, 0.9880.9740.960, 0.9830.0050.002, 0.00970.9480.904, 0.9720.9860.969, 0.993
2001180.9430.895, 0.9690.9270.870, 0.9600.0080.004, 0.01780.9320.886, 0.9610.9780.947, 0.991
2002140.9110.866, 0.9410.8640.803, 0.9090.0190.009, 0.04060.8520.688, 0.9370.9350.818, 0.979
2003180.9240.896, 0.9460.8940.854, 0.9230.0180.011, 0.02960.8150.685, 0.8990.8640.730, 0.938
2004190.9260.905, 0.9420.9070.885, 0.9250.0150.010, 0.02250.8610.771, 0.9200.9300.767, 0.982
2005120.9400.911, 0.9600.9030.869, 0.9300.0090.005, 0.01850.8670.798, 0.9150.9170.845, 0.957
200690.9210.899, 0.9380.8980.874, 0.9170.0100.005, 0.02040.8660.777, 0.923--
200740.9280.917, 0.9380.9100.852, 0.9600.0050.002, 0.009-----
Tab.8  Yearly summarized tuberculosis treatment outcomes in newly diagnosed cases in the mainland of China
YearNumber of studiesSuccess rate95% CICure rate95% CIFailed rate95% CI
199250.7580.677, 0.8250.4670.214, 0.7390.1770.242, 0.126
199390.820.709, 0.8940.7020.628, 0.7670.0780.131, 0.045
1994100.8840.807, 0.9330.7970.740, 0.8450.0400.081, 0.020
1995110.8820.819, 0.9250.8490.779, 0.9000.0550.118, 0.025
1996110.8870.828, 0.9280.8530.793, 0.8980.0380.095, 0.015
1997120.9270.902, 0.9460.9140.876, 0.9410.0220.047, 0.010
1998120.9150.858, 0.9510.8790.798, 0.9310.0360.106, 0.012
1999110.9150.868, 0.9470.8820.824, 0.9230.0180.040, 0.008
2000110.9240.865, 0.9580.9070.845, 0.9450.0210.039, 0.011
2001160.8660.785, 0.8330.8180.736, 0.8790.0340.052, 0.022
2002140.8240.753, 0.8770.7540.679, 0.8170.0520.123, 0.021
2003160.8470.805, 0.8810.7970.760, 0.8290.0510.085, 0.030
2004140.8620.827, 0.8900.8260.792, 0.8560.0310.046, 0.021
200590.8800.821, 0.9220.8220.756, 0.8740.0230.039, 0.013
200660.8560.802, 0.8970.7740.654, 0.8610.0400.091, 0.017
200740.8520.801, 0.8910.7950.731, 0.8460.0260.057, 0.012
Tab.9  Table 6 Yearly summarized tuberculosis treatment outcomes in previously treated cases in the mainland of China
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