Supplementary file 1_Severe pre-treatment attrition in the care cascade: clinical outcomes and risk factors among older MDR/RR-TB patients in China.docx

Older patients face unique challenges, yet age-stratified analyses of the MDR/RR-TB care cascade are lacking, obscuring the specific barriers they encounter.</p>Objective<p>This study aimed to characterize the treatment cascade and identify factors associated with attrition among older MDR/RR-TB patients in China.</p>Methods<p>We conducted a retrospective cohort study of 667 MDR/RR-TB patients aged ≥65 years in Guangdong Province, southern China (2010–2022).

Using data from the national Tuberculosis Information Management System (TIMS), we constructed a care cascade to quantify attrition across four stages (diagnosis, treatment initiation, retention at 6 months, and treatment success) and three inter-stage gaps (attrition between successive stages). Separate multivariable logistic regression models identified factors associated with failure to initiate treatment and with poor outcomes.</p>Results<p>Of the 667 diagnosed patients (median age 70), 500 (74.96%) initiated treatment, 406 (60.87% of diagnosed cases, 81.2% of treated cases) were retained at 6 months, and only 268 (40.18% of diagnosed cases, 53.6% of treated cases) achieved treatment success.