Epidemiological Characteristics and Spatiotemporal Cluster Analysis of Multidrug-Resistant and Rifampicin-Resistant Tuberculosis Among Older People - China, 2019-2025.

INTRODUCTION

Multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) in older individuals remains a significant public health challenge in China. This study evaluated the epidemiological characteristics and spatiotemporal patterns of MDR/RR-TB in individuals aged ≥65 years in China between 2019 and 2025.

METHODS

Data were obtained from the China Information System for Disease Control and Prevention (CISDCP). Spatiotemporal distribution and demographic characteristics of MDR/RR-TB cases in China were analyzed using descriptive epidemiological methods. Global Moran's I and local indicators of spatial association were employed to assess spatial clustering, and spatiotemporal scanning was performed using the SaTScan software to detect high-risk clusters.

RESULTS

From 2019 to 2025, 21,569 patients with MDR/RR-TB aged ≥65 years were registered across 31 provincial-level administrative divisions nationwide [1.72% of all pulmonary tuberculosis (PTB) in older patients]. The notification rate of MDR/RR TB among older people declined in 2022 and then rebounded in 2025. The proportion of MDR/RR-TB among older patients with PTB increased. The patients were predominantly male (73.3%) in the 65-69-year age group. Of the cases, 46.0% were retreated, and 83.3% underwent molecular diagnostic testing. Heilongjiang and Gansu were persistent high-high cluster areas, whereas Xinjiang presented the highest risk. Spatiotemporal scanning identified significant clusters in Xinjiang, the three northeastern provinces, Chongqing-Guizhou, and Ningxia-Shaanxi-Gansu.

CONCLUSIONS

The proportion of MDR/RR-TB among older patients with PTB in China increased significantly. The clusters were mainly located in the central-western and northeastern regions. We recommend strengthening drug resistance surveillance, expanding molecular testing coverage in high-risk areas, and optimizing treatment strategies for retreated patients.