Epidemiology of drug–resistant tuberculosis in Hunan China over a 10–year period

Background Drug–resistant tuberculosis (DR–TB) remains a major public health challenge in China, yet long–term epidemiological data from key regions such as Hunan Province in South–Central China are still limited. Objective This study aimed to characterize the epidemiological trends, spatial distribution, and risk factors of Single drug–resistant tuberculosis (SDR–TB), poly–drug–resistant tuberculosis (PDR–TB), multidrug–resistant tuberculosis (MDR–TB), rifampicin–resistant tuberculosis (RR–TB), and isoniazid–resistant tuberculosis (INH–R TB) in Hunan Province between 2014 and 2023, to inform region–specific control strategies. Methods It was a retrospective analysis that was conducted on 6,597 laboratory–confirmed DR–TB cases. Data were obtained from the Provincial Tuberculosis Control Institute. All patients underwent phenotypic drug susceptibility testing. Independent risk factors for DR–TB subtypes were identified through multivariable logistic regression, with adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) calculated. Results A total of 6,597 patients with DR–TB were included in this 10–year analysis. Among them, 74.97% were male and 64.44% were farmers. The highest case burden was observed in the 50–59 age group (24.78%). Spatially, cases clustered mainly in the Changsha (16.39%), Shaoyang (13.78%), and Loudi (9.05%). The most common resistance subtypes were INH–R TB (56.27%) and MDR–TB (52.37%). The distribution of all DR–TB subtypes varied significantly across age groups ( p < 0.05), with peaks in middle–aged and older adults. Over time, the detection rate of MDR–TB was highest in 2018, while RR–TB remained the most frequently detected resistance type. Multivariable analysis identified significant regional and demographic disparities. The eastern region of Hunan was associated with an increased risk of SDR–TB (OR = 1.334) and PDR–TB (OR = 1.208), whereas the western region carried the highest risk for MDR–TB (OR = 1.734). Female patients consistently showed lower risks of MDR–TB (OR = 0.819) and RR–TB (OR = 0.784) compared with males. Conclusion This study presents a 10–year epidemiological assessment of DR–TB in Hunan Province, China, covering 2014–2023. A disproportionately high burden was observed among middle–aged and older male farmers. The predominance of INH–R TB and MDR–TB, together with distinct regional and demographic risk profiles, underscores an urgent need to strengthen TB control measures. These results support the implementation of targeted interventions, including intensified screening in high–risk populations and in high–incidence areas, along with optimized treatment regimens, to curb the ongoing DR–TB epidemic in South–Central China.