The epidemiology and disease economic burden of osteoarticular tuberculosis in hospitalized children in China: a nationwide cross-sectional retrospective study

Osteoarticular tuberculosis (OATB) in children may lead to bone and joint deformities, which seriously affect the growth and development of children. However, the epidemiological data on pediatric OATB are relatively scarce. The goal of this study is to understand the epidemiological characteristics and economic burden of OATB in hospitalized children in China. We conducted a retrospective, multicenter cross-sectional study covering hospitalized children with OATB in 24 hospitals in six regions of China from 2016 to 2021. Sociodemographic and geographic variables, admission and discharge information were extracted from face sheets of discharge medical records to describe the epidemiological characteristics. Length of hospital stay (LOS) and hospitalization expenses were used to assess economic burden. Pediatric OATB inpatients accounted for 5.25% of pediatric TB hospitalizations (322/6138). Among different regions, Southwest China had the highest prevalence of OATB among TB patients (9.72%). The prevalence of OATB among ethnic minority children was higher than that among Han children (7.12% vs. 4.79%). Among all the children with OATB, 75.47% (243/322) were solo OATB, while OATB combined with pulmonary tuberculosis accounted for only 14.91% (48/322). In terms of anatomical distribution, spinal tuberculosis was the most common, accounting for 38.83% (125/322). In terms of economic burden, the median length of stay (LOS) for OATB patients was 12 days (IQR 7–17), with a median total hospitalization expense of $1319.61 (IQR 700.53-2788.25). Notably, Northwest China recorded the longest median LOS(14 days). Additionally, ethnic minority children had a longer median LOS than Han children (14 days vs. 11 days). This study contained the largest number of pediatric inpatients with OATB, which is the first multi-center study of pediatric OATB in China. The burden of hospitalized children with OATB in the western region of China and ethnic minorities is serious. It is recommended to take region - targeted prevention and treatment measures for children with OATB to reduce the risk of disease transmission and protect children’s health.