Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China

Authors: Chengchao Zhou, Qian Long, Jiaying Chen, Li Xiang, Qiang Li, Shenglan Tang, Fei HuangEmail author, Qiang SunEmail author and Henry Lucas



Tuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households. A number of studies have analyzed patient and household expenditure on TB care, but there does not appear to be any that have assessed the incidence, intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China. That will be the objective of this paper.


The data used for this study were derived from the baseline survey of the China Government – Gates Foundation TB Phase II program. Our analysis included 747 TB cases. Catastrophic health expenditure for TB care was estimated using two approaches, with households defined as experiencing CHE if their annual expenditure on TB care: (a) exceeded 10 % of total household income; and (b) exceeded 40 % of their non-food expenditure (capacity to pay). Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE.


The incidence of CHE was 66.8 % using the household income measure and 54.7 % using non-food expenditure (capacity to pay). An inverse association was observed between CHE rates and household income level. Significant determinants of CHE were: age, household size, employment status, health insurance status, patient income as a percentage of total household income, hospitalization and status as a minimum living security household. Factors including gender, marital status and type of TB case had no significant associations with CHE.


Catastrophic health expenditure incidence from TB care is high in China. An integrated policy expanding the free treatment package and ensuring universal coverage, especially the height of UHC for TB patients, is needed. Financial and social protection interventions are essential for identified at-risk groups.


Catastrophic health expenditure - Tuberculosis - Determinants - China

Citation: Chengchao Zhou, Qian Long, Jiaying Chen, Li Xiang, Qiang Li et al. Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China Infectious Diseases of Poverty 2016 5:6 DOI: 10.1186/s40249-016-0100-6

Received: 22 July 2015 Accepted: 8 January 2016 Published: 25 January 2016

Copyright: © Zhou et al.2016 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Competing interests

The authors declare there are no competing interests.

Authors’ contributions

CZ, QS conceived the idea, CZ, ST, QL, JC, LX, QL, FH and QS implemented the field study. CZ, QS and HL participated in the statistical analysis and interpretation of the results. CZ mainly wrote the manuscript. HL, ST, FH and QS gave many valuable comments on the draft and also polished it. Both of FH and QS are corresponding authors of this manuscript, and contributed equally to this paper. All authors read and approved the final manuscript.

Quality assurance

The questionnaire and survey procedures were tested in a pilot study carried out in Zhenjiang city in March 2013 and then refined before use in the three project cities. Key researchers from the above four Chinese universities acted as survey supervisors to check the consistency and quality of the data collected.

Ethical consideration

The Ethical Committee of China CDC reviewed and approved the study protocols and instruments. Informed consents were obtained from all study participants.