湖北省石首市和巴东县肺结核患者就诊和卫生系统延迟情况及影响因素分析

卢星星 刘勋 李涛 叶建君 张梦娴 张玉 杨成凤 陈伟 周丽平

卢星星, 刘勋, 李涛, 叶建君, 张梦娴, 张玉, 杨成凤, 陈伟, 周丽平. 湖北省石首市和巴东县肺结核患者就诊和卫生系统延迟情况及影响因素分析[J]. 疾病监测, 2021, 36(10): 1010-1016. doi: 10.3784/jbjc.202104270229
引用本文: 卢星星, 刘勋, 李涛, 叶建君, 张梦娴, 张玉, 杨成凤, 陈伟, 周丽平. 湖北省石首市和巴东县肺结核患者就诊和卫生系统延迟情况及影响因素分析[J]. 疾病监测, 2021, 36(10): 1010-1016. doi: 10.3784/jbjc.202104270229
Lu Xingxing, Liu Xun, Li Tao, Ye Jianjun, Zhang Mengxian, Zhang Yu, Yang Chengfeng, Chen Wei, Zhou Liping. Factors associated with health care-seeking delay and treatment delay in pulmonary tuberculosis patients in Shishou and Badong of Hubei[J]. Disease Surveillance, 2021, 36(10): 1010-1016. doi: 10.3784/jbjc.202104270229
Citation: Lu Xingxing, Liu Xun, Li Tao, Ye Jianjun, Zhang Mengxian, Zhang Yu, Yang Chengfeng, Chen Wei, Zhou Liping. Factors associated with health care-seeking delay and treatment delay in pulmonary tuberculosis patients in Shishou and Badong of Hubei[J]. Disease Surveillance, 2021, 36(10): 1010-1016. doi: 10.3784/jbjc.202104270229

湖北省石首市和巴东县肺结核患者就诊和卫生系统延迟情况及影响因素分析

doi: 10.3784/jbjc.202104270229
基金项目: 国家科技重大专项(No.2017ZX10201302–007)
详细信息
    作者简介:

    卢星星,女,湖北省襄阳市人,硕士,主管医师,主要从事结核病预防与控制工作,Email:814596127@qq.com

    通讯作者:

    陈伟,Tel:010–58900537,Email:chenwei@chinatb.org

    周丽平,Tel:027–87652268,Email:372008131@qq.com

  • 中图分类号: R211; R521

Factors associated with health care-seeking delay and treatment delay in pulmonary tuberculosis patients in Shishou and Badong of Hubei

Funds: This study was supported by the National Technology and Science Major Projects (No. 2017ZX10201302–007)
More Information
  • 摘要:   目的  对湖北省2个县(市)的肺结核病患者的就诊和卫生系统延迟情况进行调查,分析其影响因素,为结核病患者早发现,早治疗提供依据。  方法  采用横断面调查,通过现场面对面的询问和收集患者的病案信息、医院门诊记录和住院记录的方式调查患者的就诊和诊疗信息,应用单因素分析和多因素logistic回归分析进行影响因素分析。  结果  肺结核患者的就诊延迟中位数为7(P25P75∶0~30)d,咳嗽或咳痰(OR=1.97,95%CI: 1.04~3.75),到达首次就诊医疗机构的距离>20 km (OR=2.35,95%CI: 1.36~4.06)为就诊延迟的危险因素,胸痛(OR=0.47,95%CI: 0.25~0.89)为就诊延迟的保护因素。 肺结核患者卫生系统延迟的中位数为24(P25P75: 13~54)d,就诊次数和就诊的不同医疗机构数为患者卫生系统延迟的危险因素(P<0.05),且就诊次数和就诊的不同医疗机构数越多,结核病患者发生卫生系统延迟的风险越大。 肺结核患者总延迟的中位数为56(P25P75: 26~138)d,咳嗽或咳痰(OR=2.37, 95%CI: 1.14~4.95),痰涂片阳性(OR=2.07, 95%CI: 1.16~3.68),到达最近结核病定点医疗机构距离>30 km(OR=1.92,95%CI: 1.04~3.55),就诊次数3~4次(OR=2.50,95%CI: 1.25~4.97)和就诊次数>4次(OR=25.42,95%CI: 5.19~124.44)均为患者总延迟的危险因素(P<0.05)。  结论  本研究中肺结核患者总延迟主要由卫生系统延迟造成,在采取有效措施减少患者就诊延迟的同时,还需要改善患者的就医行为,优化患者就医路径,提高非结核病定点医疗机构对结核病的警觉性和诊疗水平,发挥分子生物学检查等手段在患者筛查中作用,提高结核病诊断水平,减少患者卫生系统延迟。
  • 表  1  肺结核患者就诊延迟、卫生系统延迟和总延迟单因素分析

    Table  1.   Risk factors for health care-seeking, treatment and total delays in TB patients

    影响因素病例数及构成比(%)就诊延迟卫生系统延迟总延迟
    病例数及构成比(%)χ2P病例数及构成比(%)χ2P病例数及构成比(%)χ2P
    性别0.000.9760.350.5530.7950.373
     女性113(34.24)55(48.67)57(50.44)60(53.10)
     男性217(65.76)106(48.85)102(47.00)104(47.93)
    年龄组(岁)8.660.013b4.280.11811.9770.003b
     <3063(19.09)21(33.33)23(36.51)19(30.16)
     30~123(37.27)60(48.78)62(50.41)68(55.28)
     >60144(43.64)80(55.56)74(51.39)77(53.47)
    文化程度4.540.1035.110.0788.4630.015b
     高中及以上89(26.97)37(41.57)35(39.33)33(37.08)
     小学或初中171(51.82)83(48.54)84(49.12)90(52.63)
     文盲或半文盲70(21.21)41(58.57)40(57.14)41(58.57)
    婚姻状况12.150.0025.360.06913.5430.001
     已婚230(69.70)125(54.35)114(49.57)124(53.91)
     未婚69(20.91)21(30.43)26(37.68)21(30.43)
     离异或丧偶31(9.39)15(48.39)19(61.29)19(61.29)
    医保0.620.4321.770.1840.4930.482
     无医保8(2.42)5(62.50)2(25.00)3(37.50)
     有医保322(97.58)156(48.45)157(48.76)161(50.00)
    职业6.100.2971.830.8729.5880.088
     学生42(12.73)14(33.33)17(40.48)12(28.57)
     教师、医务人员、干部职员、离退人员24(7.27)12(50.00)13(54.17)11(45.83)
     商业性服务人员37(11.21)17(45.95)19(51.35)20(54.05)
     农民128(38.79)63(49.22)61(47.66)66(51.56)
     民工、工人52(15.76)28(53.85)27(51.92)28(53.85)
     无业或不详47(14.24)27(57.45)22(46.81)27(57.45)
    居住地经济类型24.6800.0002.790.09523.5070.000
     城镇161(48.79)56(34.78)70(43.48)58(36.02)
     农村169(51.21)105(62.13)89(52.66)106(62.72)
    每天工作时间2.420.1202.440.1186.4350.011
     <6 h160(48.48)71(44.38)70(43.75)68(42.50)
     ≥6 h170(51.52)90(52.94)89(52.35)96(56.47)
    家庭中收入最高的人0.000.9941.700.1931.2360.266
     否209(63.33)102(48.80)95(45.45)99(47.37)
     是121(36.67)59(48.76)64(52.89)65(53.72)
    因治疗结核借钱0.850.3581.750.1853.1580.076
     否199(60.30)93(46.73)90(45.23)91(45.73)
     是131(39.70)68(51.91)69(52.67)73(55.73)
    临床症状
     咳嗽或咳痰229(69.39)136(59.39)49.23<0.001116(50.66)1.860.395136(59.39)31.981<0.001
     咯血39(11.82)19(48.72)42.92<0.00116(41.03)1.460.48121(53.85)20.832<0.001
     发热46(13.94)25(54.35)42.15<0.00122(47.83)0.390.82123(50.00)21.232<0.001
     胸痛63(19.09)25(39.68)50.01<0.00137(58.73)3.550.16927(42.86)25.037<0.001
     消瘦23(6.97)15(65.22)43.11<0.00111(47.83)0.380.82614(60.87)21.26<0.001
    合并症
     糖尿病34(10.30)21(61.76)2.560.11016(47.06)0.020.89025(73.53)8.6120.003
     慢性阻塞性肺疾病20(6.06)11(55.00)0.330.56612(60.00)1.190.27512(60.00)0.9040.342
     高血压35(10.61)18(51.43)0.110.74115(42.86)0.450.50518(51.43)0.0470.828
    痰涂片15.74<0.0013.550.06025.589<0.001
     阴性202(61.21)81(40.10)89(44.06)78(38.61)
     阳性128(38.79)80(62.50)70(54.69)86(67.19)
    首次就诊机构类型2.210.52920.11<0.0014.6360.200
     结核病定点/专科医院185(56.06)85(45.95)73(39.46)84(45.41)
     其他综合性医院/中医院67(20.30)37(55.22)33(49.25)34(50.75)
     基层医疗卫生服务机构68(20.61)35(51.47)44(64.71)39(57.35)
     私人诊所10(3.03)4(40.00)9(90.00)7(70.00)
    到达首次就诊医疗机构的距离(km)a12.35<0.0011.9680.1613.4180.064
     ≤20132(40.37)49(37.12)70(53.03)58(43.94)
     >20195(59.63)111(56.92)88(45.13)106(54.36)
    到达最近结核定点医疗机构的距离(km)aNA8.350.00415.22<0.001
     ≤30188(58.20)78(41.49)77(40.96)
     >30135(41.80)78(57.78)85(62.96)
    就诊次数NA61.81<0.00140.758<0.001
     1~194(58.79)60(30.93)71(36.60)
     3~108(32.73)73(67.59)67(62.04)
     >428(8.48)26(92.86)26(92.86)
    就诊的不同医疗机构数(个)NA48.19<0.00115.0460.001
     1146(44.24)44(30.14)59(40.41)
     2129(39.09)69(53.49)66(51.16)
     >255(16.67)46(83.64)39(70.91)
    接受过关于结核的知识3.620.0570.0230.884.8960.027
     否175(53.03)94(53.71)85(48.57)97(55.43)
     是155(46.97)67(43.23)74(47.74)67(43.23)
    知道结核病定点医疗机构2.900.0890.0310.8611.7910.181
     否181(54.85)96(53.04)88(48.62)96(53.04)
     是149(45.15)65(43.62)  71(47.65)68(45.64)  
      注:到达首次就诊医疗机构的距离、到达最近结核定点医疗机构的距离均采用中位数描述集中趋势,并用中位数进行分组;基层医疗卫生服务机构包括乡镇卫生院、村卫生室、社区卫生服务中心、站;就诊次数:是指患者在开始治疗前,去各个医疗机构就诊的次数;就诊的不同医疗机构数:是指患者在开始治疗前,辗转不同的医疗机构数(不包括在同一医疗机构重复就诊);a. 缺失值;NA. 未应用这个变量;b. P<0.05
    下载: 导出CSV

    表  2  肺结核患者就诊延迟、卫生系统延迟和总延迟多因素logistic分析结果

    Table  2.   Multivariate logistic analysis on factors related to health care-seeking, treatment and total delays inTB patients

     影响因素就诊延迟卫生系统延迟总延迟
    OR值(95% CIPOR值(95% CIPOR值(95% CIP
    年龄组(岁)
     <301.001.00
     30~0.27(0.07~1.00) 0.049b1.04(0.31~3.52)0.955
     >600.35(0.09~1.33)0.1220.97(0.26~3.56)0.960
    文化程度
     高中及以上1.00
     小学或初中0.88(0.38~2.03)0.756
     文盲或半文盲1.29(0.46~3.63)0.625
    婚姻状况
     已婚1.001.00
     未婚0.31(0.09~1.05)0.0600.67(0.21~2.14)0.504
     离异或丧偶0.88(0.39~1.99)0.7551.31(0.51~3.35)0.576
    职业
     学生
     教师、医务人员、干部职员、
     离退人员
     商业性服务人员
     农民
     民工、工人
     无业或不详
    居住地经济类型
     城镇1.001.00
     农村1.67(0.97~2.87)0.0640.97(0.51~1.84)0.928
    每天工作时间(h)
     <61.00
     ≥61.40(0.78~2.54)0.264
    因为结核病治疗借钱
     否
     是
    临床症状
     咳嗽或咳痰1.97(1.04~3.75) 0.038b2.37(1.14~4.95) 0.022b
     咯血0.54(0.26~1.14)0.1041.00(0.45~2.24)0.994
     发热1.30(0.64~2.66)0.4680.98(0.45~2.15)0.958
     胸痛0.47(0.25~0.89) 0.021b0.57(0.28~1.15)0.115
     消瘦2.48(0.91~6.75)0.0771.36(0.47~3.88)0.571
     糖尿病2.50(0.96~6.55)0.062
    痰涂片
     阴性1.001.00
     阳性1.43(0.85~2.41)0.1840.2292.07(1.16~3.68) 0.014b
    首次就诊机构类型
     结核病定点/专科医院1.00
     其他综合性医院/中医院0.46(0.19~1.13)0.091
     基层医疗卫生服务机构0.63(0.26~1.56)0.314
     私人诊所 5.35(0.57~50.46)0.143
    到达首次就诊医疗机构的距离(km)a
     ≤201.00
     >202.35(1.36~4.06) 0.002b
    到达最近结核定点医疗机构的距离(km)aNA
     ≤301.001.00
     >301.45(0.85~2.45)0.1721.92(1.04~3.55) 0.037b
    就诊次数NA
     1~1.001.00
     3~2.76(1.48~5.19)0.002b2.50(1.25~4.97) 0.009b
     >421.62(4.79~97.53)<0.001b 25.42(5.19~124.44)<0.001b
    就诊的不同医疗机构数(个)NA
     11.001.00
     22.46(1.08~5.60)0.031b0.84(0.44~1.59)0.587
     >2 6.70(1.97~22.86)0.002b0.85(0.30~2.43)0.759
    接受过关于结核的知识
     否1.00
     是0.77(0.45~1.32)0.340
      注:到达首次就诊医疗机构的距离、到达最近结核定点医疗机构的距离均采用中位数描述集中趋势,并用中位数进行分组;基层医疗卫生服务机构包括乡镇卫生院、村卫生室、社区卫生服务中心、站;就诊次数是指患者在开始治疗前,去各个医疗机构就诊的次数;就诊的不同医疗机构数:是指患者在开始治疗前,辗转不同的医疗机构数(不包括在同一医疗机构重复就诊);a. 缺失值;NA. 未应用这个变量;−. 未纳入模型分析;b. P<0.05
    下载: 导出CSV
  • [1] World Health Organization. Global tuberculosis control report 2020[R]. Geneva: World Health Organization, 2020.
    [2] Hussen A, Biadgilign S, Tessema F, et al. Treatment delay among pulmonary tuberculosis patients in pastoralist communities in Bale Zone, Southeast Ethiopia[J]. BMC Res Notes, 2012, 5: 320. DOI: 10.1186/1756−0500−5−320.
    [3] Belkina TV, Khojiev DS, Tillyashaykhov MN, et al. Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a cross-sectional study[J]. BMC Infect Dis, 2014, 14: 624. DOI: 10.1186/s12879−014−0624−y.
    [4] 省人民政府办公厅关于印发“十三五”湖北省结核病防治规划的通知[EB/OL]. (2017−11−21) [2021−04−13]. http://www.hubei.gov.cn/zfwj/ezbf/201712/t20171208_1713488.shtml.

    General Office of Provincial People's Government. Notice on the the 13th Five-year Plan for tuberculosis prevention and control plan of Hubei province[EB/OL]. (2017−11−21)[2021−04−13]. http://www.hubei.gov.cn/zfwj/ezbf/201712/t20171208_1713488.shtml.
    [5] Ngadaya ES, Mfinanga GS, Wandwalo ER, et al. Delay in tuberculosis case detection in Pwani region, Tanzania. A cross sectional study[J]. BMC Health Serv Res, 2009, 9: 196. DOI: 10.1186/1472−6963−9−196.
    [6] Maciel ELN, Golub JE, Peres RL, et al. Delay in diagnosis of pulmonary tuberculosis at a primary health clinic in Vitoria, Brazil[J]. Int J Tuberc Lung Dis, 2010, 14(11): 1403–1410.
    [7] Sebastian NM, Haveri SP, Nath AS. Delay in diagnosis of tuberculosis and related factors from a district in Kerala, India[J]. Indian J Tuberc, 2021, 68(1): 59–64. DOI:  10.1016/j.ijtb.2020.09.008.
    [8] 颜凤霞. 山东省农村肺结核病人卫生系统延迟及影响因素研究[D]. 济南: 山东大学, 2008. DOI:  10.7666/d.y1351948.

    Yan FX. The study on health system delay and influential factors of the rural tuberculosis patient in Shandong province[D]. Ji'nan: Shandong University, 2008. DOI:  10.7666/d.y1351948.
    [9] 景睿, 王美花, 王晓婷, 等. 济南市肺结核患者就诊延迟及其影响因素分析[J]. 结核病与肺部健康杂志,2019,8(2):106–110. DOI:10.3969/j.issn.2095−3755.2019.02.007.

    Jing R, Wang MH, Wang XT, et al. Analysis of patient delay and influencing factors among pulmonary tuberculosis patients in Ji'nan city[J]. J Tuber Lung Heal, 2019, 8(2): 106–110. DOI: 10.3969/j.issn.2095−3755.2019.02.007.
    [10] Zhao XX, Yang P, Gai RY, et al. Determinants of health care-seeking delay among tuberculosis patients in Shandong province, China[J]. Eur J Public Health, 2014, 24(5): 757–761. DOI:  10.1093/eurpub/ckt113.
    [11] 张晓龙, 王斐娴, 陈水平, 等. 苏州市流动肺结核患者就诊延迟状况及影响因素[J]. 国际流行病学传染病学杂志,2019,46(1):61–65. DOI:10.3760/cma.j.issn.1673−4149.2019.01.014.

    Zhang XL, Wang FX, Chen SP, et al. Study on health-seeking delay and influencing factors associated with pulmonary tuberculosis among floating population in Suzhou[J]. Inter J Epidemiol Infect Dis, 2019, 46(1): 61–65. DOI: 10.3760/cma.j.issn.1673−4149.2019.01.014.
    [12] Wang WB, Jiang QW, Abdullah ASM, et al. Barriers in accessing to tuberculosis care among non-residents in Shanghai: a descriptive study of delays in diagnosis[J]. Eur J Public Health, 2007, 17(5): 419–423. DOI:  10.1093/eurpub/ckm029.
    [13] 薛浩, 刘荣海, 张红军, 等. 2009-2015年盐城市肺结核患者就诊延迟影响因素分析[J]. 现代预防医学,2018,45(4):757–760.

    Xue H, Liu RH, Zhang HJ, et al. Analysis of patient delay and the influencing factors of pulmonary tuberculosis in Yancheng city during 2009–2015[J]. Mod Prev Med, 2018, 45(4): 757–760.
    [14] Gebeyehu E, Azage M, Abeje G. Factors associated with patient's delay in tuberculosis treatment in Bahir Dar city administration, Northwest Ethiopia[J]. Biomed Res Int, 2014, 2014: 701429. DOI:  10.1155/2014/701429.
    [15] Rabin AS, Kuchukhidze G, Sanikidze E, et al. Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia[J]. Int J Tuberc Lung Dis, 2013, 17(2): 214–220. DOI:  10.5588/ijtld.12.0395.
    [16] Takarinda KC, Harries AD, Nyathi B, et al. Tuberculosis treatment delays and associated factors within the Zimbabwe national tuberculosis programme[J]. BMC Public Health, 2015, 15: 29. DOI: 10.1186/s12889−015−1437−7.
    [17] Sabawoon W, Sato H, Kobayashi Y. Delay in the treatment of pulmonary tuberculosis: a report from Afghanistan[J]. Environ Health Prev Med, 2012, 17(1): 53–61. DOI: 10.1007/s12199−011−0219−9.
    [18] Getnet F, Demissie M, Assefa N, et al. Delay in diagnosis of pulmonary tuberculosis in low-and middle-income settings: systematic review and Meta-analysis[J]. BMC Pulm Med, 2017, 17(1): 202. DOI: 10.1186/s12890−017−0551−y.
    [19] Jurcev-Savicevic A, Mulic R, Kozul K, et al. Health system delay in pulmonary tuberculosis treatment in a country with an intermediate burden of tuberculosis: a cross-sectional study[J]. BMC Public Health, 2013, 13: 250. DOI: 10.1186/1471−2458−13−250.
    [20] Ukwaja KN, Alobu I, Nweke CO, et al. Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study[J]. BMC Health Serv Res, 2013, 13: 25. DOI: 10.1186/1472−6963−13−25.
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出版历程
  • 收稿日期:  2021-04-27
  • 网络出版日期:  2021-07-22
  • 刊出日期:  2021-10-30

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