BackgroundDespite many treatment guidelines available now, the treatment patterns of major depressive disorder (MDD) in China haven't been well-understood due to complexity and diversity.AimTo describe pharmacological treatment patterns of MDD patients in real-world settings using electronic health records from a major psychiatric hospital in China.MethodsMDD patients (18–65 years, ICD-10: F32.x, F33.x) newly initiated single antidepressant (AD) in 2015 were enrolled, the date of first AD prescription during the study period was defined as index date, and eligible patients were followed up to 1 year. Treatment patterns were revealed and analyzed using multi-channel sequence analysis (MCSA), considering patients' chronological sequences (in days) of AD prescription, cumulative treatment step(s), and polypharmacy usage during the follow-up.ResultsThis study (n = 5,003) identified four types of MDD treatment patterns. The first type (1-time treatment) represents the largest proportion of patients (73.6%, n = 3,686), followed by the second type (6-month consistent treatment) and third type (long-term, consistent treatment) collectively accounted for 20.6% (n = 1,031) of patients, by contrast the last type (long-term, inconsistent treatment) made up the rest 5.7% (n = 286) of patients while exhibiting the most complicated treatments patterns. The choice of AD was dominated by selective serotonin reuptake inhibitors (SSRIs), while treatment duration spent in polypharmacy spanned at 2.8%, 16.4%, 2.0%, and 36.5% over the four types, respectively.ConclusionTreatment patterns reflecting real-world pharmacological treatment practices of MDD in China were revealed using MCSA. The observed discrepancies between real-world practice and treatment guidelines provided additional insights in improving the clinical management of MDD.

Objective To estimate whether WHO's End TB Strategy targets can be achieved by analysing the incidence trend of pulmonary tuberculosis in Shanghai during 1992–2016. Method The age‐adjusted annual incidence of tuberculosis (TB) was calculated based on data from the national TB registration system. Linear regression was applied to analyse the trend of the epidemic, together with the statistical indicator of annual percent change (APC). Results The overall age‐standardised rate decreased from 34.8/100 000 in 1992 to 21.2/100 000 in 2016, or by 2.15% (t = −13.258, P < 0.05) annually. After rapidly declining between 1999 and 2003 (−5.4% p.a.), the epidemic remained at a stable level with a lower annual declining rate (−1.1% p.a). In 2035, the estimated incidence will be 17.2/100 000 based on the APC in 2004–2016. There were two peaks in average incidence of the total population, 30.9/100 000 in the 20–24 age group and 66.4/100 000 in the 70–74 age group. Overall, the ratio of new to retreated cases continually rose and eventually reached 8.36:1 in 2016. The constituent ratio of smear‐positive cases ranged from 35.9% to 47.8% without rising or decreasing trend (P = 0.065). Conclusion The epidemic of TB in Shanghai has steadily declined during last two decades. A new strategy should be developed to rapidly reduce the incidence rate to achieve the WHO Goals in 2035.

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Background: Antidepressant (AD) algorithm is an important tool to support treatment decision-making and improve management of major depressive disorder (MDD). However, little is known about its concordance with real-world practice. This study aimed to assess the concordance between the longitudinal treatment patterns and AD algorithm recommended by a clinical practice guideline in China.Methods: Data were obtained from the electronic medical records of Shanghai Mental Health Center (SMHC), one of the largest mental health institutions in China. We examined the concordance between clinical practice and the Canadian Network for Mood and Anxiety Treatments (CANMAT) algorithm among a cohort composed of 19,955 MDD patients. The longitudinal characteristics of treatment regimen and duration were described to identify the specific inconsistencies. Demographics and health utilizations of the algorithm-concordant and -discordant subgroups with optimized treatment were measured separately.Results: The overall proportion of algorithm-concordant treatment significantly increased from 84.45% to 86.03% during the year of 2015–2017. Among the patients who received recommended first-line drugs with subsequent optimized treatment (n = 2977), the concordance proportion was 27.24%. Mirtazapine and trazodone were the most used drugs for adjunctive strategy. Inadequate or extended duration before optimized treatment are common inconsistency. The median length of follow-up for algorithm-concordant (n = 811) and algorithm-discordant patients (n = 2166) were 153 days (Q1-Q3 = 79–328) and 368 days (Q1-Q3 = 181–577) respectively, and the average number of clinical visits per person-year was 13.07 and 13.08 respectively.Conclusion: Gap existed between clinical practice and AD algorithm. Improved access to evidence-based treatment is required, especially for optimized strategies during outpatient follow-up.