Abstract:

Objective: To analyze the medication adherence and its influencing factors among pulmonary tuberculosis (PTB) patients in Chongqing from 2021 to 2024, and to provide a scientific basis for improving treatment outcomes. Methods: A retrospective study was conducted using medical records of PTB patients registered between 2021 and 2024, extracted from the Tuberculosis Information System,a subsystem of the China Information System for Disease Control and Prevention. The chi-square test and multivariate logistic regression were used to identify factors associated with medication adherence. Results: A total of 46321 PTB patients registered in Chongqing from 2021 to 2024 were included, with an overall regular medication rate of 98.10% (45440/46321), showing a significant increasing trend over the years ($\chi_{\text {trend}}^2$=50.858,P<0.001). The regular medication rate was higher in the main urban area (98.92%,21350/21583) and the northeastern urban agglomeration (98.57%,15795/16024), but relatively lower in the southeastern urban agglomeration (95.19%,8295/8714), with a statistically significant difference (χ²=491.962,P<0.001). Multivariate logistic regression analysis showed that patients of Tujia ethnicity (OR=1.82, 95%CI:1.45-2.29), Miao ethnicity (OR=4.68, 95%CI:3.71-5.90), and other ethnic minorities (OR=3.83, 95%CI:1.37-10.73) had lower adherence than Han patients.Compared with students,agricultural workers (OR=4.49,95%CI:1.86-10.86), government/institution staff (OR=4.23,95%CI:1.59-11.26), enterprise employees (OR=4.82,95%CI:1.92-12.09), commercial/service personnel (OR=3.30,95%CI:1.20-9.02), and other occupations (OR=3.51,95%CI:1.46-8.46) all had lower adherence. Retreatment cases (OR=1.28,95%CI:1.03-1.59) had lower adherence than initial treatment cases; patients on self-administered medication (OR=2.01, 95%CI:1.54-2.63) had lower adherence than those under supervised medication; patients using anti-tuberculosis fixed-dose combination (FDC)(OR=1.24, 95%CI:1.04-1.47) had lower adherence than non-users; patients with severe adverse reactions (OR=4.90, 95%CI:3.33-7.20) had lower adherence than those without; and patients identified through direct visits (OR=2.79, 95%CI:1.67-4.66), referral (OR=2.17, 95%CI:1.33-3.52), or tracing (OR=1.95, 95%CI:1.16-3.29) had lower adherence than those detected via health checkups, active screening, or other methods. Conclusion: The overall medication adherence among PTB patients in Chongqing was relatively high, with distinct temporal and spatial characteristics. Targeted interventions should be developed to improve adherence among high-risk groups, including ethnic minorities, agricultural workers, government/institution staff, enterprise employees, and commercial/service personnel, as well as patients who are retreatment cases, on self-administered medication, using anti-tuberculosis FDC, experiencing severe adverse reactions, and detected through passive case-finding approaches, in order to reduce the risk of unfavorable treatment outcomes.

Key words: Tuberculosis, pulmonary, Medication adherence, Factor analysis, statistics