SERIOUS CHRONIC DISEASES IN CHINA: DIABETES, CANCER, HEPATITIS AND TUBERCULOSIS

SERIOUS DISEASES IN CHINA

Major causes of death in China include communicable diseases and injuries. China has the greatest number of tuberculosis cases of any UN-member state. The risk of getting major infectious diseases is high (2020). In the mid-1980s the leading causes of death in China were similar to those in the industrialized world: cancer, cerebrovascular disease, and heart disease. Rates of cancer have risen since then. Some diseases have been linked to water and air pollution. Widespread smoking and a preference for televisions over refrigerators is believed to related to a high rate of disease among some Chinese. [Source: CIA World Factbook, 2022; Library of Congress]

Health figures from China are often absent or sketchy. "Publication of...data is an important step towards improving healthcare in China and should be cherished as an opportunity that could translate into saving hundreds of thousands of lives," Gregg Stone, a professor at Columbia University Medical Center in New York, told AFP. “It would help to pinpoint geographical gaps in hospital coverage and advise emergency doctors on the best treatment for STEMI patients, he said.

Diarrhea mortality has substantially declined in recent decades in Chinese children. The vast majority of rotavirus deaths occurred in rural areas. From 2003 to 2012, a total of 127,539 deaths from diarrhea were reported among Chinese children less than five years of age, of which an estimated 53,559 (42 percent) had illness attributable to rotavirus. Comparing 2003 to 2012, the annual number of deaths from rotavirus diarrhea decreased by 74 percent (from 10,531 to 2,791, respectively) and the mortality rate fell 74 percent (from 0.66 to 0.17 deaths per 1000 live births, respectively). Ninety-three percent of all rotavirus deaths occurred in rural areas, where mortality rates (0.33 deaths per 1000 live births in 2012) were 11 times greater than in urban areas (0.03 deaths per 1000 live births in 2012). There is potential value in using rotavirus vaccine interventions in rural areas to further reduce mortality from this disease. [Source: Jing Zhang, MD, et. Rotavirus-specific and Overall Diarrhea Mortality in Chinese Children Younger than 5 Years, October 1, 2016]

China’s laws formally ban foreigners entering the country with “serious psychiatric illness, infectious pulmonary tuberculosis and other infectious diseases that may constitute a major threat to public health.” It used to ban all foreigners with “psychiatric illness, leprosy, AIDS, sexually-transmitted diseases, active pulmonary tuberculosis and other infectious diseases.” In April 2010, China lifted the ban on people with HIV/AIDS and leprosy entering the country.

Heart Disease in China

A total of 5.09 million cardiovascular disease (CVD) deaths were estimated in China in 2019, with a mortality rate and age-standardized mortality rate of 364.5 per 100,000 population and 276.0 per 100,000, respectively. Stroke is the leading cause of death, and the mortality rate and age-standardized mortality rate (ASMR) were 171.6 per 100,000 and 130.0 per 100,000, respectively. The second major cause was ischemic heart diseases, and the mortality rate and ASMR were 147.3 per 100,000 and 142.1 per 100,000, respectively. Stroke and ischemic heart diseases were the two major causes of CVD deaths, which accounted for over 87 percent of all CVD deaths. [Source: Jiangmei Lium et. Al, “Cardiovascular Disease Mortality — China, 2019", China CDC Wkly, April 9, 2021]

Hospitalisation in China for the most serious form of heart attack more than quadrupled between 2001 and 2011 according to research published on Tuesday in The Lancet. AFP reported: In 2001, Chinese hospitals admitted 3.7 people per 100,000 population for a type of cardiac arrest known as ST-segment elevation myocardial infarction, or STEMI. In 2011, this rose to 15.8 people per 100,000. [Source: AFP, June 24, 2014]

“The study, based on admission records from 162 hospitals, was not designed to explore the reasons for the rise. The authors, though, suggest more people were exposed to heart-attack risk during this period — rates for smoking, high blood pressure, diabetes and cholesterol increased — while at the same time access to emergency treatment probably improved. "We know that this period was marked by an increasing prevalence of cardiovascular risk factors and that China has launched healthcare reform, which recently doubled annual expenditures for health care to improve access," said Jing Li of the Chinese Academy of Medical Sciences.

Cancer in China

China has high rates of liver, stomach and esophageal cancer. Some of these diseases have been linked to water pollution. Air pollution has been blamed for China's rising rates of cancer and respiratory disease. Rates of breast cancer used to be five times lower in China than in the United States but the gap is narrowing among urban Chinese. Many attribute the change to changes in diet.

Some of the more prevalent forms of fatal cancers included cancer of the stomach, esophagus, liver, lung, and colon-rectum. The frequency of these diseases was greater for men than for women, and lung cancer mortality was much greater in higher income areas. The degree of risk for the different kinds of cancers varied widely by region. For example, nasopharyngeal cancer was found primarily in south China, while the incidence of esophageal cancer was higher in the north.

Cancer rate (age-standardized rate per 100,000 people): 203; men: 224.3; women: 187, compared to 468; men: 578; women: 363 in Australia and 242; men: 289; women: 212; in Bulgaria
Liver cancer (rate per 100,000 people): 18.2, 8th in the world; men: 27.6, 8 th in the world;
Liver cancer (deaths per 100,000 people): 17.2, 8th in the world; men: 26.1, 9th in the world;
Oesophageal (food pipe) cancer (rate per 100,000 people): 13.8, 4th in the world; men: 19.7. 4th in the world; women: 8.2, 8th in the world.
Oesophageal cancer (deaths per 100,000 people): 12.7, 4th in the world; men: 18.3, 4th in the world; women: 7.4, 8th in the world.
Stomach cancer (rate per 100,000 people): 20.6, 5th in the world; men: 29.4, 6th in the world; women: 12.3, 8th in the world.
Stomach cancer (deaths per 100,000 people): 15.9, 3rd in the world; men: 22.8, 5th in the world; women: 9.5, 7th in the world.
[Source: World Cancer Research Fund wcrf.org ]

Cancer in Cancer Country China

Jiayang Fan wrote in The New Yorker: “Shanxi is in the heart of China’s coal country, and has disproportionately high rates of esophageal and lung cancer. Zhixia was only five months old when her father, a farmer, died of esophageal cancer.” Her mother “remarried, but her second husband succumbed to lung cancer....When she was twenty-five, she met her husband, a coal miner named Zhang Wei. [Source: Jiayang Fan, The New Yorker, March 30, 2020]

“Three years into Zhixia’s” battle with breast cancer, “n the spring of 2017, Wei felt a pain in his back so severe that he couldn’t lift up their son. He didn’t go to a doctor: caring for Zhixia left little time, and he figured that he’d hurt himself while swimming. Two weeks later, the pain was so bad that he couldn’t get out of bed. When he finally went to a doctor, he was informed that he had a blood disorder. The doctor, who suspected late-stage leukemia, told him to check in to the hospital right away. Wei said that he needed to keep working, to pay for his wife’s treatment.

“Wei died on a brisk fall day, three months later. What pained Zhixia the most was knowing that he had been alone at the end. His mother was too distraught to enter his hospital room, his father had been at work in the coal mines, Zhixia had been receiving another round of chemo, and her own mother was busy caring for Xuan. In the days after, Zhixia told her mother, “Please don’t let me die.” By then, she knew that she had cancer: her father-in-law, who was illiterate, had inadvertently let her see one of her medical reports.

Cancer and Pollution in China

Some of cancers have been linked to water pollution. Air pollution has been blamed for China's rising rates of cancer and respiratory disease. Gastrointestinal cancer is now the number one killer in the countryside. It is estimated that nearly two thirds of China’s rural population — more than 500 million people — use water contaminated by human and industrial waste.

Joseph Kahn and Jim Yardley wrote in the New York Times, “Pollution has made cancer China’s leading cause of death....Only 1 percent of the country’s city dwellers breath air considered safe.” In industrial cities people rarely see the sun; children become sickened by lead poisoning. Coastal areas and even lakes suffer from red tides; rivers emit fumes that make people feel sick and gives them cancer.

Sheng Keyi wrote in the New York Times: Rural residents are more likely than urban residents to die of stomach and intestinal cancers, presumably because of polluted water. State media reported on one government inquiry that found 110 million people across the country reside less than a mile from a hazardous industrial site. [Source: Sheng Keyi, New York Times, April 4, 2014]

According to the Los Angeles Times: “Although China's Communist Party is more candid about pollution than it used to be, the topic remains a sensitive one. Many Chinese doctors and researchers turn down requests for interviews, saying it's too risky to speak to foreign journalists. Wei Zhang, a Chinese-born cancer researcher at the University of Texas MD Anderson Cancer Center in Houston, said he was stunned that so few speakers mentioned pollution at a major conference on cancer last month in Tianjin. "In the plenary session, I think I was the only person who brought up the term 'air pollution,'" Zhang said. "Ten years ago, it was sensitive to talk about smoking because the tobacco industry was so important to the Chinese economy. Now it feels safe to talk about smoking. But for pollution, people are not prepared to talk about it," he said. [Source: Barbara Demick, Los Angeles Times, December 24, 2013]

“Yet research on the connection between pollution and cancer remains in its infancy in China. To learn more, researchers say, Chinese health authorities must establish cancer registries, collecting case histories of new patients. Those records then must be matched with detailed air pollution data going back over the years it takes for lung cancer to develop. "It is not going to be easy laboratory research. You need to build up an infrastructure over time," Zhang said. "And of course, the Chinese government has to come on board so researchers don't feel like they're doing something secret."

Lung Cancer in China

Lung cancer rate (age-standardized rate per 100,000 people): men: 35.1; women: 22.8. China’s cancer mortality rate has soared, climbing 80 percent between 1984 and 2014. About 3.5 million people are diagnosed with cancer each year, 2.5 million of whom die. According to the Los Angeles Times “In a country that manufactures 1.7 trillion cigarettes a year, smoking is still cited as the leading cause of lung cancer. But these days, only about half of Chinese men smoke, down from 63 percent in 1996. Many blame pollution. [Source: World Cancer Research Fund, Los Angeles Times, New York Times]

Mark Parascandola and Lin Xiao wrote: China is in the midst of a lung cancer epidemic on an unprecedented scale. In 2015, there were an estimated 733,000 new lung cancer cases (17 percent of total cancer incidence) and 610,000 deaths (21.7 percent of total cancer mortality) in China. Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality in China. Tobacco smoke exposure is the primary factor driving current lung cancer trends. In 2015, smoking prevalence was 27.7 percent (52.1 percent among men and 2.7 percent among women). China has taken substantial steps to control tobacco use in recent years, including 19 cities implementing comprehensive smoke free laws and expansion of cessation services. However, significant challenges remain in order to meet the 2030 Healthy China goal of reducing smoking prevalence to 20 percent. In particular, ongoing attention is needed to continuing to control secondhand smoke exposure, to further enhance smoking cessation services, and to address novel alternative nicotine delivery devices (ANDS). [Source: Mark Parascandola, Lin Xiao, “Tobacco and the lung cancer epidemic in China”, Translational Lung Cancer Research, Home / Vol 8, Supplement 1 (May 2019)]

Lung Cancer and Pollution in China

Lung cancer is the leading form of cancer in China, and while smoking, especially among men, is a prime culprit, the contribution of PM2.5, the dangerous fine particles suspended in smog, can not be ignored. “PM2.5 was declared a carcinogen by the World Health Organization as early as 2013,” Dr. Zhao Xiaogang, deputy chief of thoracic surgery at Shanghai Pulmonary Hospital of Tongji University, told the New York Times. “No matter how developed the medical technology is, if people are exposed to smog, especially severe smog, they are at risk.” Global Times quoted him as making a direct link. “The intense rise in lung cancer,” he said, “is intimately related to smog.”[Source: Karoline Kan, Sinosphere, New York Times, January 6, 2017]

Chinese doctors are beginning to speak out about the link between air pollution and lung cancer, which has even begun to affect children.Barbara Demick wrote in the Los Angeles Times: “The youngest known lung cancer patient in eastern China is an 8-year-old girl whose home is next to a dust-choked road in heavily industrialized Jiangsu province. Another patient was a 14-year-old girl from Shanghai, the daughter of two nonsmokers with no family history of lung cancer. Back in the 1970s, when Bai Chunxue was in medical school, the textbook lung cancer patient was a chain-smoking male in his 60s. Nowadays, Bai, one of the physicians who treated the teen, sees so many who are still in their 20s that the cases blend together. "When I see patients who are not smokers with no other risk factors, we have to assume that the most probable cause is pollution," said Bai, who works at Shanghai's Zhongshan Hospital and is chairman of the Shanghai Respiratory Research Institute.[Source: Barbara Demick, Los Angeles Times, December 24, 2013]

“Increasingly, other Chinese physicians are reaching the same conclusion. At a time when cigarette smoking is on the decline in China, the nation is facing an explosion of lung cancer cases. From 2002 to 2011, the incidence of lung cancer in Beijing rose to 63 cases per 100,000, from 39.6, according to municipal health authorities. Nationwide in the last three decades, an era in which China opened up its economy and industrialized, deaths from lung cancer have risen 465 percent.”

One of the main culprits, “doctors believe, is the fine particulate matter known as PM 2.5, the microscopic particles from exhaust, coal smoke and vehicle fumes that can burrow their way into lungs. Readings in Beijing and elsewhere in northern China frequently climb straight off the chart devised by the World Health Organization, which classifies particulate levels between 300 and 500 micrograms per cubic meter as hazardous.

“Though the Chinese news media are replete with stories about pollution, connecting the dots between dirty air and the rising cancer rate is risky. The doctor who first disclosed the case of the 8-year-old girl with lung cancer last month to a reporter from the state-run China News Service appears to have been publicly silenced. "There was a misunderstanding. I can't do an interview," said Feng Dongjie of the Jiangsu Province Tumor Hospital in Nanjing.

“Although China's Communist Party is more candid about pollution than it used to be, the topic remains a sensitive one. Many Chinese doctors and researchers turn down requests for interviews, saying it's too risky to speak to foreign journalists. “Researchers at Fudan University School of Public Health in Shanghai were chastised last month for reporting on an experiment in which water contaminated with fine particulate matter was injected into the lungs of laboratory rats. Photos of the blackened lungs went viral on Chinese social media sites before China's state media jumped in, running large editorials attacking the researchers for injecting the solution rather than letting the mice breathe polluted air. "The dramatic imagery whipped Net users into a frenzy," complained the Global Times, a newspaper close to the Communist Party, which went on to quote the chief researcher on the experiment, Song Weimin, saying that "the effects have been exaggerated in media reports and the effects on humans will not be so severe."

“European researchers, however, say the techniques used at Fudan are legitimate. Injection is a fairly standard procedure with animal experiments because it is very hard to do inhalation studies with rodents. They are not very cooperative in that way," said Dana Loomis, a leading expert on outdoor air pollution with the World Health Organization's International Agency for Research on Cancer.

“In October, the agency formally classified outdoor air pollution as a major carcinogen. With the levels of pollution existing in Europe, the risks associated with exposure to air pollution are comparable to passive smoking," Loomis said. "You could expect higher risks in more polluted areas." Another WHO agency reported in 2010 that air pollution was responsible for 3.2 million deaths worldwide, 223,000 of them from lung cancer. About half the cases are believed to have been in Asia.

Diabetes in China

Diabetes is increasingly becoming a serious problem in China. The disease is growing there in sheer numbers faster than anywhere else in the world. The number of people suffering from diabetes has reached 92 million in China, almost 10 per cent of its population of 1.3 billion, according to a March 2010 study in the New England Journal of Medicine. By the mid 2010s, the number reached 114 million.

In a nationally representative cross-sectional study conducted in mainland China with 173 642 participants in 2018, the estimated overall prevalence of diabetes was 12.4 percent and prediabetes was 38.1 percent, with awareness of diabetes in 36.7 percent of cases, treatment in 32.9 percent, and adequate control in 50.1 percent. Among the 170,287 participants enrolled in 2013, the estimated prevalence of diabetes was 10.9 percent and of prediabetes was 35.7 percent. [Source: “Prevalence and Treatment of Diabetes in China, 2013-2018" Limin Wang et.al. JAMA. 2021;326(24):2498-2506, December 28, 2021]

Only one third of those who have diabetes have been diagnosed and of those only about half are being treated. Many Chinese have traditionally used herbal medicines to treat their condition and do not even know what insulin treatments is. The Chinese government is starting to aggressively seek help from the large international drug companies on treating and containing the disease.

Lucy Hornby of Reuters wrote: “In 30 years, the Chinese people have gone from having barely enough to eat to worrying about spreading waistlines, leaving the healthcare system struggling to keep up with an exponential rise in "nobleman diseases" like diabetes. "In the last 20 years, diabetes has developed a lot, but it's only now showing up in the medical system," said Dr Tong Xiaolin, vice director of the Guanganmen Hospital in Beijing, who sees dozens of patients during Monday office hours. "People are now just flooding into the system in real numbers. The next 10 years will be a real drain on the system." [Source: Lucy Hornby, Reuters, March 26, 2012]

“Spending on diabetes reached $17 billion in China in 2011, a tiny amount compared with the $465 billion spent worldwide, according to a white paper from Singapore's Saw Swee Hock School of Public Health and the Harvard School of Public Health. That represents about 5 percent of total healthcare spending in China, with some estimates rising to 13 percent. In the United States, where costs have ballooned, diabetes accounts for about $1 in every $10 spent on healthcare, according to the American Diabetes Association. Spending on diabetes at U.S. levels of $201 billion a year would swamp China's system, leaving it unable to tackle other priorities.

Diabetes Increasing at an Alarming Rate in China, Especially Among Younger People

Diabetes is becoming common with younger and younger people in China. One out of every 20 diabetes sufferers in Beijing is 13 or younger. Many blame the trend on increased obesity occurring at younger and younger ages and a more fat- and sugar-laden Westernized diet and fast food. Most new cases are Type II diabetes which associated with obesity and lack of exercise. Some Asian ethnic groups are particularly susceptible to Type II diabetes.

The number of diabetics in China is expected to rise to 130 million by 2030. "We were very surprised and couldn't believe how fast it grew," Peking Union Medical College Hospital specialist Xiang Hongding told Reuters after a typical morning spent seeing 22 patients in four hours. The rapid growth means diabetes often goes unrecognized until secondary symptoms appear, making treatment much harder. [Source: Lucy Hornby, Reuters, March 26, 2012]

“Adding to the burden, Asians in their prime earning years of 30-50 are more likely to develop diabetes than Caucasians, according to the Saw Swee Hock white paper on diabetes. "When I found out, my heart was very heavy. I worried I wouldn't be able to support my family. I was afraid I couldn't function in this economy," said patient Wang Yuanqing, father of an 8-year-old, whose diabetes weighs heavily on him even though he has kept it under control since his diagnosis a year ago.

Diagnosing and Treating Diabetes in China

Lucy Hornby of Reuters wrote: “Liu Yuxiang travels five hours to Beijing every month to see Dr Tong, and reckons she has spent 30,000 yuan ($4,700) on Chinese medicines to treat painful and swollen legs. Western drugs to control blood sugar cost her another 12,000 yuan a year, 80 percent of which is covered by insurance. “If we didn't have a doctor in the family I would never have known. No one around us had any knowledge of it," said the cheerful 64-year-old, who suffered from years of thirst, fainting fits and hospitalization before her daughter-in-law suggested she might have diabetes. [Source: Lucy Hornby, Reuters, March 26, 2012]

“Many doctors, especially in the countryside, have no inkling that diabetes could be the underlying cause for a number of symptoms -- including blindness, numb or tingling legs, digestive disorders and circulatory problems. "Diabetes is very easy to diagnose, but even so, most doctors don't know how to do that," said Xiang, 68, who got his early medical training during China's tumultuous Cultural Revolution and now teaches rural doctors in diabetes diagnosis. "The patients don't know, and when they get to us they say the doctors didn't know.”

“Basic medicine to keep diabetes under control is relatively cheap in China, at about 2,000 yuan ($320) a year. But treatment for a patient who has developed advanced symptoms could easily reach 18,000 yuan a year, roughly equal to the average yearly income of urban Chinese. Common drugs for diabetes are covered by insurance, but equipment for at-home testing and monitoring of blood sugar levels -- which can reach 400 yuan a month -- is not.

“Catching diabetes early could help drug makers like Novo Nordisk, the top seller of insulin in China, or Bayer, which markets a drug that helps reduce glucose absorption after meals. Both help educate on diabetes in China.Traditional Chinese medicine developers could also benefit. Guanganmen Hospital's Tong Xiaolin has received more than 9 million yuan in government grants to study how Chinese medicine can offer lower-cost, effective treatment of diabetes complications.

“Traditional Chinese medicine has a real role to play in treating complications," he said, as patients trooped through his office. He consulted records handwritten in blue notebooks, while nurses prepared the next patient in line. "Chinese medicine is very helpful in controlling nausea, or depression due to pain. Some patients are in such pain they can't sleep and consider suicide," Tong said. Better education of doctors and patients, and standardizing Chinese medicine dosages, could also reduce reliance on the "quack" medicine that proliferates in the teeming communities that ring China's mega-cities.

Respiratory Diseases in China

Respiratory diseases cause nearly a quarter of all deaths in China, compared with 2 or 3 percent in the United States. Rates are particularly high in the countryside, where respiratory disease is the number one killer. Many respiratory diseases are air pollution related. Even though women smoke less than men they suffer equally from diseases like lung cancer and bronchitis.

The Harvard School of Public Health has estimated that 65 million people will die from chronic obstructive pulmonary disease and 18 million will die from lung cancer between 2003 and 2033 from smoking and burning fuel indoors with chronic obstructive pulmonary disease accounting for around 19 percent of all deaths and hung cancer, 5 percent.

Air pollution is also linked with a variety of respiratory aliments. Around some factories the asthma rate is 5 percent. It is estimated that 26 percent of all deaths in China are caused by respiratory illnesses (compared with 2 or 3 percent in the U.S.). Many people in Beijing and Shanghai get hacking coughs. In rural areas, respiratory disease is the number one killer. It is impossible to say how many are caused by air pollution though and how many are caused by smoking or some other cause.

Tuberculosis in China

China has the greatest number of tuberculosis cases of any UN-member state. In the late 2000s, there were 29.7 cases of the disease per 100,000 people, compared to 56.7 per 100,000 in Russia; 34.3 in Japan; 15.0 in Germany; 10.6 in Britain, and 8.7 in the United States. Drug-resistant tuberculosis is widespread in several provinces of China.

Estimates of tuberculosis rates in China (2020, total number — rate per 100 000)
Total TB incidence: 842 000 (717 000-978 000) — 59 (50-68)
HIV-positive TB incidence: 12 000 (10 000-14 000) — 0.84 (0.71-0.98)
HIV-negative TB mortality: 30 000 (27 000-33 000) — 2.1 (1.9-2.3)
HIV-positive TB mortality: 2 100 (1 600-2 700) — 0.15 (0.11-0.19)
[Source: World Health Organization who.int/tb ]

Universal health coverage and social protection
TB treatment coverage (notified/estimated incidence), 2020: 74 percent (64-87)
TB case fatality ratio (estimated mortality/estimated incidence), 2020: 4 percent (3-5)

TB case notifications, 2020
Total new and relapse: 624 715
Percent tested with rapid diagnostics at time of diagnosis: 45 percent
Percent with known HIV status: 68 percent
Percent pulmonary: 95 percent
Percent bacteriologically confirmed : 55 percent
Percent children aged 0-14 years: 1 percent
Percent women (aged ≥15 years): 31 percent
Percent men (aged ≥15 years): 68 percent
Total cases notified: 633 156

TB/HIV care in new and relapse TB patients, 2020 (Number — percent)
Patients with known HIV status who are HIV-positive: 6 076 — 1.4 percent
- on antiretroviral therapy: 5 287 — 87 percent

Drug-resistant TB care, 2020
Bacteriologically confirmed TB cases tested for rifampicin resistance - New cases: 83 percent
Bacteriologically confirmed TB cases tested for rifampicin resistance - Previously treated cases: 97 percent
Laboratory-confirmed cases - MDR/RR-TB : 16 343
Patients started on treatment - MDR/RR-TB : 13 250
Laboratory-confirmed cases - pre-XDR-TB or XDR-TB : 1 185
Patients started on treatment - pre-XDR-TB or XDR-TB : 947
MDR/RR-TB cases tested for resistance to any fluoroquinolone: 4 726

Treatment success rate and cohort size (Success — Cohort)
New and relapse cases registered in 2019: 94 percent — 711 965
Previously treated cases, excluding relapse, registered in 2019: 87 percent — 6 204
HIV-positive TB cases registered in 2019: 71 percent — 7 715
MDR/RR-TB cases started on second-line treatment in 2018: 54 percent — 8 965

TB financing
National TB budget, 2021: US$901 millions
- Funding source, domestic: 88 percent
- Funding source, international: 0.021 percent
- unfunded: 12 percent

One in Ten Cases of Tuberculosis in China Are Drug-Resistant

In June 2012, AP reported: “One in 10 cases of tuberculosis in China cannot be treated by the most commonly-used drugs. Researchers say the findings from the 2007 survey on drug-resistant TB, published in the New England Journal of Medicine, show that the government must invest more in public health services to better diagnose drug-resistant strains of the killer lung disease. Hospitals must also be prevented from routinely misusing drugs that worsen the problem, they say. [Source: AP, June 7, 2012]

"For the first time, we have a representative, national survey of this problem in China. It shows that this is pretty serious," said Dr. Daniel Chin, a TB expert at the Bill & Melinda Gates Foundation in Beijing who is one of the study's authors. "One in 10, by any standard globally, would be pretty high." The proportion of drug-resistant TB found in the survey was in line with previous estimates that were based on provincial studies, the researchers said. While the survey was done in 2007, the researchers said it took time to culture and test samples from each patient.

“The survey conducted by the Chinese Center for Disease Control and Prevention, or China CDC, also showed that 8 percent of patients with drug-resistant TB were actually extensively drug-resistant cases. The survey's researchers tested 4,000 TB patients recruited through local TB clinics over nine months. In 2007, an estimated 110,000 cases of drug-resistant TB and 8,200 extensively drug-resistant cases developed, making it the largest annual number of new drug-resistant cases in the world, the study said. "This is a very grave situation because we don't have any new drugs to treat the patients with," said Dr. Wang Yu, director of the China CDC and another author of the study. "It is a problem that the whole world is facing... and over time, it will only increase.”

China's rate of drug-resistant TB cases is lower than in some Eastern European countries, but the absolute number of cases, given the country's large population, is high - similar to that of India. In the past decade, China made marked progress in fighting tuberculosis, which until recent years was the most fatal infectious disease. But many state-run TB facilities still don't have the resources to test patients for drug-resistant strains in order to give them the right drugs, and many are also unable to track every patient to ensure that drug regimens are closely followed.

“The survey also showed that patients who were last treated in a tuberculosis hospital were 13 times as likely to have drug-resistant TB as those who had been treated elsewhere. They likely became infected in the hospitals or were given the wrong drugs. The overuse and misuse of antibiotics is very common in China because it is a way for underfunded hospitals to boost revenue through drug sales. The hospital is clearly a major culprit in this, even what we call tuberculosis hospitals which are supposed to be specialized in the treatment of drug-resistant TB, they are actually perhaps, as this study has implicated, contributing to drug-resistant TB," said Chin, who is also deputy director of programs at the Gates Foundation in China.

Hepatitis B in China

Hepatitis is a big problem in China. It accounts for a large proportion of deaths. Around 700 million Chinese, more than half the population, have had hepatitis B. Of these 120 million, 10 percent of the population, are believed to be long term carriers, who can transmit the disease for years even though they show no outward symptoms. About 25 percent of these will ultimately suffer from some kind of complication related to the disease. In 2004 health officials announced that China had some 120 million hepatitis B virus carriers.

Hepatitis B is spread primarily from mother to infant and from reused needles, which are often used in clinics to save money. In China abut 40 percent of sufferers they the disease form their mothers. By some estimates about 90 percent of those who have had hepatitis were infected at birth. The 10 percent that caught it later on are mainly the ones who become carriers. Many were infected with needles that were reused during vaccination campaigns for tuberculosis and tetanus and encephalitis in the 1970s, 80s ad 90s. Many people get Hepatitis B from their mothers and many show no symptoms. Even so they are denied jobs and placement in schools because blood tests pick up the disease. Some people who know they have the disease don’t date, refuse to get married or don’t tell their spouses.

Hepatitis B killed 808 people a day in China, compared to eight a day in the United States. The Chinese government did little to contain the disease until 2005, when it started a program of free vaccine for infants, by that time it had already become an epidemic. In 2006, Beijing announced that fighting the disease was a top priority and celebrities with it came forward and said the were hepatitis B carriers.

People who are known to have hepatitis are widely discriminated against. They are denied certain jobs and even fired from existing jobs. In many cases employees are discovered to have the disease during annual company physicals. They are let go on the spot with three months salary as severance pay. Students with the disease have been forced to move into segregated dormitories. A ban against employing civil servants with hepatitis B was only lifted in 2005. Carriers of the disease are still not allowed to work in the food industry, public restrooms, hotels and beauty parlors. Some who were denied jobs have sued for discrimination. One man even killed the official who denied him a job.

Battling Hepatitis B in China

Many Chinese with the disease fail to get medicine or treatment because of the stigma attached to it. For that seek help, the best Western-made drugs such as Baraclude by Bristol-Meyers-Squibb can be prohibitively expensive, costing $60 to $150 a month. Western drug companies are aggressively moving into China, seeing opportunities for profits and growth. Some are working with non-profit groups to bring the cost of treatment down. Thus far the government has not stepped into help with treatment in a significant way.

Hepatitis B is so widespread that the government has embarked on a national hepatitis B immunization program for young children. So far the immunization campaign has been extensive in the rich coastal areas (around 70 percent) but less widespread in the Western province (less than 50 percent) and Tibet (5 percent). Some Chinese doctors say the idea for screening parents for hepatitis is a good one. To make sure the immunization campaign reaches total coverage, the government has earmarked $78 million for the program. A group sponsored by Bill Gates has also pitched in and donated special syringes that automatically become unusable after one use. The three-dose vaccine cost only $3 in China. In some places it costs only $1.50.

In the 1990s, the New-Jersey-based mulinational drug company Merck helped the Chinese company Shenzhen Kangtai build drug-manufacturing facility in the city of Shenzhen and gave the company the biological technology to produce a hepatitis B vaccine royalty free, according to the New York Times, “ as part of an unusual joint venture aimed at improving health standards in China. At the time, up to two million Chinese children were being infected annually with hepatitis B. Since then, China has made great strides in early vaccinations under a national program subsidized by the government. And Shenzhen Kangtai became the country’s biggest producer of hepatitis B vaccines, with a 60 percent market share, according to China’s state-run news media. [Source: David Barboza, New York Times, December 25, 2013]

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Last updated September 2022