Risk Management and Healthcare Policy (Jun 2021)

Persistent Discrimination of TB in Southeastern China: Results from Four Repeated Population-Based Surveys During the Period of 2006–2018

  • Chen X,
  • Wang W,
  • Hua Q,
  • Xu H,
  • Wang F,
  • Liu K,
  • Peng Y,
  • Chen B,
  • Jiang J

Journal volume & issue
Vol. Volume 14
pp. 2333 – 2344


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Xinyi Chen,1,* Wei Wang,1,* Qianhui Hua,2,* Hong Xu,3 Fei Wang,1 Kui Liu,1 Ying Peng,1 Bin Chen,1 Jianmin Jiang1,4 1Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China; 2School of Medicine, Ningbo University, Ningbo, People’s Republic of China; 3Department of Tuberculosis Control and Prevention, Xiaoshan District Center for Disease Control and Prevention, Hangzhou, People’s Republic of China; 4Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bin Chen; Jianmin Jiang Tel/Fax +86-571-8711-5183Email [email protected]; [email protected]: To analyze the changes in discriminatory attitudes and isolated behaviors of the public toward tuberculosis (TB) in the Zhejiang Province and to determine the associated factors with TB discrimination.Methods: Data were obtained from four cross-sectional population-based investigations from 2006 to 2018. A total of 26,246 respondents were interviewed using unified questionnaires that measured knowledge, attitudes, and behaviors regarding TB. The changes in public attitudes and behaviors towards TB over time were analyzed. The effect of socio-demographic factors and the level of TB awareness on TB discriminatory attitudes and isolated behaviors were evaluated.Results: The results of these four cross-sectional studies found that TB discrimination had not changed much over the decade. Overall, discriminatory attitudes were present in 63.5% of the respondents who knew about TB (81.2%). Nearly 31.2% of those who reported being surrounded by people with TB (5.8%) showed isolated behaviors. Older respondents, those with a low education level, and farmers were prone to having discriminatory attitudes or behaviors. Those aware of the infectiousness and transmission routes of TB, and those who felt that TB was serious were more likely to discriminate against TB (P < 0.001). Those aware that TB can be cured were non-discriminatory (aOR = 0.77, 95% CI: 0.72– 0.82).Conclusion: Discriminatory attitudes and isolated behaviors toward TB have not changed significantly in southeastern China over the survey years, and persistent discrimination against TB still exists among the public. The multiple causes of discrimination cannot be addressed through basic health education. Tailor-made strategies, relevant policy measures, and an enabling social environment for TB are urgently required.Keywords: tuberculosis, discrimination, attitude, behavior