Influencing factors associated with health-care seeking delay and diagnosis delay of pulmonary tuberculosis patients in Western China, 2020
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摘要:
目的 了解我国2020年西部地区肺结核患者的就诊及诊断延迟情况,分析肺结核患者就诊及诊断延迟的影响因素,为我国西部地区肺结核防治政策的制定提供参考依据。 方法 本研究为横断面调查,采用整群抽样的方法选取我国西部12个省份的16家结核病定点医疗机构,2020年10—12月对其中在治且治疗时间大于2周的药物敏感肺结核患者进行面对面问卷调查,调查内容包括患者的基本信息、诊疗信息等。 对患者人口学特征、就诊延迟及诊断延迟情况等进行描述性分析,采用χ2检验进行单因素分析,采用多因素logistic回归分析结核病患者就诊延迟和诊断延迟的影响因素。 结果 本研究共调查1030例肺结核患者,其中纳入就诊延迟分析856例;纳入诊断延迟分析987例。 结果显示,2020年我国西部地区肺结核患者就诊时间中位数为9(3, 35)d,就诊延迟发生率为41.24%(353/856),初治[比值比(OR)=2.183,95%置信区间(CI):1.172~4.064]、患有其他慢性病(OR=1.551,95%CI:1.152~2.088)为肺结核患者发生就诊延迟的危险因素;家庭年收入≥40000元(40000~元:OR=0.252,95%CI:0.169~0.376;≥60000元:OR=0.258,95%CI:0.170~0.391)为肺结核患者就诊延迟的保护因素。 我国西部地区肺结核患者诊断时间中位数为12(3, 33)d,诊断延迟率为44.48%(439/987),年龄≥65岁(OR=2.508,95%CI:1.679~3.747)、农村(OR=2.479,95%CI:1.798~3.419)、流动人口(OR=4.347,95%CI:1.355~13.945)为肺结核患者诊断延迟危险因素;采用分子生物学方式诊断结核病(OR=0.499,95%CI:0.312~0.796)为患者诊断延迟的保护因素。 结论 我国西部地区结核病患者的就诊延迟和诊断延迟现象均较为普遍,建议针对重点人群,加强结核病宣传教育,提高基层医疗机构结核病诊疗水平,从而避免肺结核患者就诊及诊断延迟的发生。 Abstract:Objective To understand the current status of health-care seeking delay and diagnosis delay in patients with pulmonary tuberculosis (TB) in western China in 2020, analyze the underlying factors associated with these delays, and provide evidence to strengthen the TB prevention and control in western China. Methods A total of 1 030 drug sensitive pulmonary TB patients who had treatment for more than 2 weeks in 16 designated tuberculosis medical institutions in 12 provinces of western China were surveyed from October to December 2020. Face-to-face questionnaire surveys were conducted to collect information about patients' baseline characteristics and diagnosis information. Descriptive analysis was performed to describe the demographic characteristics and health-care seeking delay or diagnosis delay. We used χ2 test for univariate analysis and multivariate logistic regression analysis to identify the factors associated with both health-care seeking delay and diagnosis delay in pulmonary TB patients. Results A total of 1 030 pulmonary TB patients were surveyed, in whom 856 patients and 987 patients were included in the analyses on health-care seeking and diagnosis delay, respectively. The results showed that the median health-care seeking time of TB patients in western China was 9 days (3, 35), and the health-care seeking delay rate was 41.24% (353/856). The findings indicated that initial treatment [odds ratio (OR)=2.183, 95% confidence interval (CI): 1.172–4.06] and suffering from other chronic diseases (OR=1.551, 95%CI: 1.152–2.088) were associated with an increased risk for health-care seeking delay. Conversely, family annual income >40 000 yuan (40 000– yuan: OR=0.252, 95%CI: 0.169–0.376; ≥60 000 yuan: OR=0.258, 95%CI: 0.170–0.391) was identified as an protective factor against health-care seeking delay. The median diagnosis time of pulmonary TB patients was 12 days (3, 33), with a diagnosis delay rate of 44.48% (439/987). Factors associated with diagnosis delay included age ≥65 years (OR=2.508, 95%CI: 1.679–3.747), living in rural area (OR=2.479, 95%CI: 1.798–3.419), and being floating population (OR=4.347, 95%CI: 1.355–13.945). Molecular biological diagnosis (OR=0.499, 95%CI: 0.312–0.796) was a protective factor against diagnosis delay. Conclusion Health-care seeking delay and diagnosis delay in pulmonary TB patients in western China were common. It is recommended to strengthen health education about TB prevention and control and improve the diagnosis and treatment of TB in primary medical institutions to reduce diagnosis and health-care seeking delays in TB patients. -
Key words:
- Tuberculosis /
- Pulmonary /
- Health-care seeking delay /
- Diagnosis delay /
- Influencing factor
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表 1 2020年中国西部地区肺结核患者就诊延迟单因素分析
Table 1. Univariate analysis on health-care seeking delay of pulmonary tuberculosis patients in Western China, 2020
特征 患者例数b 就诊延迟 例数(例) 延迟率(%) χ2值 P值 总体 856 353 41.24 年龄组(岁) 10.768 0.013 <25 181(21.14) 93 51.38 25~ 175(20.44) 62 35.43 45~ 287(33.53) 112 39.02 ≥65 213(24.88) 86 40.38 性别 6.867 0.009 男性 553(64.60) 210 37.97 女性 303(35.40) 143 47.19 婚姻状态 6.812 0.078 未婚 202(23.60) 93 46.04 已婚 582(67.99) 233 40.03 离婚 24(2.80) 5 20.83 丧偶 48(5.61) 22 45.83 居住地 5.989 0.014 城镇 666(77.80) 260 39.04 农村 190(22.20) 93 48.95 文化程度 2.778 0.596 文盲 156(18.22) 70 44.87 小学 273(31.89) 112 41.03 初中 265(30.96) 102 38.87 高中 99(11.57) 45 45.45 大专及以上 63(7.36) 23 36.51 家庭主要收入来源者 6.698 0.010 是 275(32.13) 96 34.91 否 581(67.87) 257 44.23 流动人口 0.132 0.717 是 13(1.52) 6 46.15 否 843(98.48) 347 41.16 患者类型 7.512 0.006 初治 795(92.87) 338 42.52 复治 61(7.13) 15 24.59 患有其他慢性病a 16.183 <0.001 否 529(61.80) 190 35.92 是 327(38.20) 163 49.85 患病前家庭年收入(元) 76.890 <0.001 <15000 247(28.86) 158 63.97 15000~ 213(24.88) 78 36.62 40000~ 208(24.30) 62 29.81 ≥60000 188(21.96) 55 29.26 注:a. 其他慢性病包括糖尿病、慢性肝炎、慢性肾炎、贫血、高血压等;b. 括号外数据为不同特征肺结核患者的例数(例),括号内数据为不同特征肺结核患者的比例(%) 表 2 2020年中国西部地区肺结核患者诊断延迟单因素分析
Table 2. Univariate analysis on diagnosis delay of pulmonary tuberculosis patients in Western China, 2020
特征 患者例数b 诊断延迟 例数(例) 延迟率(%) χ2值 P值 总体 987 439 44.48 年龄组(岁) 27.140 <0.001 <25 223(22.59) 69 30.94 25~ 217(21.99) 217 21.99 45~ 316(32.02) 152 48.10 ≥65 231(23.40) 125 54.11 性别 8.021 0.005 男性 622(63.02) 298 47.91 女性 265(36.98) 141 38.63 婚姻状态 20.862 <0.001 未婚 255(25.84) 86 33.73 已婚 649(65.75) 305 47.00 离婚 27(2.74) 18 66.67 丧偶 56(5.67) 30 53.57 居住地 46.985 <0.001 城镇 760(77.00) 292 38.55 农村 227(23.00) 146 64.32 文化程度 3.467 0.483 文盲 169(17.12) 76 44.97 小学 295(29.89) 141 47.80 初中 305(30.90) 133 43.61 高中 124(12.56) 54 43.55 大专及以上 94(9.52) 35 37.23 家庭主要收入来源者 2.754 0.097 是 330(33.43) 159 48.18 否 657(66.57) 280 42.62 流动人口 6.135 0.013 是 16(1.62) 12 75.00 否 971(98.38) 427 43.98 患者类型 2.095 0.148 初治 921(93.31) 404 43.87 复治 66(6.69) 35 53.03 诊断方法 25.663 <0.001 痰涂片 302(30.60) 158 52.32 痰培养 9(0.91) 8 88.89 分子生物学 120(12.16) 36 30.00 临床诊断 556(56.33) 237 42.63 患有其他慢性病a 2.021 0.155 否 631(63.93) 270 42.79 是 356(36.07) 169 47.47 患病前家庭年收入(元) 3.819 0.282 <15000 258(26.14) 103 39.92 15000~ 244(24.72) 118 48.36 40000~ 245(24.82) 112 45.71 ≥60000 240(24.32) 106 44.17 注:a. 其他慢性病包括糖尿病、慢性肝炎、慢性肾炎、贫血、高血压等;b. 括号外数字为不同特征肺结核患者的例数(例),括号内数字为不同特征肺结核患者的比例(%) 表 3 多因素logistic回归分析变量赋值表
Table 3. Multivariate logistic regression analysis variable assignment table
变量 赋值情况 年龄 1=<25岁;2=25岁~44岁;3=45岁~64岁;4=≥65岁 性别 1=男;2=女 婚姻状态 1=未婚;2=已婚;3=离异;4=丧偶 居住地 1=城镇;2=农村 家庭主要收入来源者 1=是;2=否 流动人口 1=是;2=否 患者类型 1=初治;2=复治 诊断方式 1=痰涂片;2=痰培养;3=分子生物学;4=临床诊断 患有其他慢性病a 1=否;2=是 患病前家庭年收入 1=<15000元;2=15000~ 元;3=40000~ 元;4=≥60000元 注:a. 其他慢性病包括糖尿病、慢性肝炎、慢性肾炎、贫血、高血压等 表 4 2020年中国西部地区肺结核患者就诊延迟多因素分析
Table 4. Multivariate analysis on health-care seeking delay of pulmonary tuberculosis patients in Western China, 2020
变量 β ${ s_{\overline x} } $ Wald χ2值 P值 OR值 95%CI 常量 −0.716 0.160 20.125 <0.001 患者类型 初治 0.390 0.159 6.055 0.014 2.183 1.172~4.064 复治 1.000 患有其他慢性病a 否 1.000 是 0.220 0.076 8.367 0.004 1.551 1.152~2.088 患病前家庭年收入(元) <15000 1.000 15000~ −0.143 0.126 1.282 0.258 0.332 0.226~0.488 40000~ −0.419 0.131 10.238 0.001 0.252 0.169~0.376 ≥60000 −0.396 0.137 8.330 0.004 0.258 0.170~0.391 注:a. 其他慢性病包括糖尿病、慢性肝炎、慢性肾炎、贫血、高血压等;β. 回归系数;$ { s_{\overline x} } $. 标准误;OR. 比值比;CI. 置信区间 表 5 2020年中国西部地区肺结核患者诊断延迟多因素分析
Table 5. Multivariate analysis on diagnosis delay of pulmonary tuberculosis patients in Western China, 2020
变量 β ${ s_{\overline x} } $ Wald χ2值 P值 OR值 95%CI 常量 1.065 0.403 6.987 0.008 年龄组(岁) <25 1.000 25~ −0.039 0.122 0.101 0.751 1.640 1.094~2.457 45~ 0.185 0.107 2.983 0.084 2.051 1.412~2.981 ≥65 0.386 0.119 10.480 0.001 2.508 1.679~3.747 居住地 城镇 1.000 农村 0.454 0.082 30.668 <0.001 2.479 1.798~3.419 流动人口 否 1.000 是 0.735 0.297 6.107 0.014 4.347 1.355~13.945 诊断方法 痰涂片 1.000 痰培养 1.471 0.809 3.309 0.069 5.382 0.647~44.764 分子生物学 −0.908 0.313 8.438 0.004 0.499 0.312~0.796 临床诊断 −0.351 0.284 1.531 0.216 0.870 0.645~1.173 注:β. 回归系数;${ s_{\overline x} } $. 标准误;OR. 比值比;CI. 置信区间 -
[1] World Health Organization. Global tuberculosis report 2022[R]. Geneva: World Health Organization, 2022. [2] Marks GB, Nguyen NV, Nguyen PTB, et al. Community-wide screening for tuberculosis in a high-prevalence setting[J]. N Engl J Med, 2019, 381(14): 1347–1357. DOI: 10.1056/NEJMoa1 902129. [3] 全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J]. 中国防痨杂志,2012,34(8):485–508.Technical Steering Group for the Fifth National Tuberculosis Epidemiological Sampling Survey, The Fifth National Tuberculosis Epidemiological Sampling Survey Office. The fifth national tuberculosis epidemiological survey in 2010[J]. Chin J Antituberc, 2012, 34(8): 485–508. [4] 陈浩. 中国结核病防治人力资源现状及配置标准研究[D]. 成都: 四川大学, 2007. DOI: 10.7666/d.y1194402.Chen H. Study on the current situation of human resources intuberculosis prevention and control system in China and the allocation standards[D]. Chengdu: Sichuan University, 2007. DOI: 10.7666/d.y1194402. [5] 辛云巧, 刘晓明. 定点综合医院结核科在结核病防治中的作用及现状[J]. 中国防痨杂志,2009,31(4):239–240.Xin YQ, Liu XM. The role and status of tuberculosis department in tuberculosis prevention and control in designated general hospitals[J]. Chin J Antituberc, 2009, 31(4): 239–240. [6] 侯惠菊. 西藏林芝市结核病防治能力现状及提高对策[J]. 当代医学,2017,23(12):56–58. DOI:10.3969/j.issn.1009−4393.2017.12.024.Hou HJ. Current status and countermeasures of tuberculosis prevention and control in Nyingchi city, Tibet[J]. Contemp Med, 2017, 23(12): 56–58. DOI: 10.3969/j.issn.1009−4393.2017.12.024. [7] World Health Organization. WHO guidelines approved by the guidelines review committee[R]. Geneva: World Health Organization, 2022. [8] 王翠萍, 郭梦玥, 郎胜利. 2016-2020年内蒙古自治区肺结核患者就诊延迟影响因素分析[J]. 疾病监测,2023,38(2):152–156. DOI: 10.3784/jbjc.202208040343.Wang CP, Guo MY, Lang SL. Influencing factors of treatment delay in pulmonary tuberculosis patients in Inner Mongolia, 2016−2020[J]. Dis Surveill, 2023, 38(2): 152–156. DOI: 10.3784/jbjc.202208040343. [9] Li T, Du X, Kang JJ, et al. Patient, diagnosis, and treatment delays among tuberculosis patients before and during COVID-19 epidemic-China, 2018–2022[J]. China CDC Wkly, 2023, 5(12): 259–265. DOI: 10.46234/ccdcw2023.047. [10] Yang Q, Tong YQ, Yin X, et al. Delays in care seeking, diagnosis and treatment of patients with pulmonary tuberculosis in Hubei, China[J]. Int Health, 2020, 12(2): 101–106. DOI: 10.1093/inthealth/ihz036. [11] 韩阳, 牛孝彬, 彭爱玲, 等. 2017-2021年淮北市结核患者就诊延迟情况及其影响因素[J/OL]. 上海预防医学, 2023: 1-8. [2023−10−17].https://kns.cnki.net/kcms/detail/31.1635.R.20230626.1442.010.html.Han Y, Niu XB, Peng AL, et al. Analysis of delayed care and its influencing factors among tuberculosis patients in Huaibei city from 2017 to 2021[J/OL]. Shanghai J Prev Med, 2023: 1-8. [2023−10−17].https://kns.cnki.net/kcms/detail/31.1635.R.20230626.1442.010.html. [12] 刘旷怡, 徐巧, 葛木村, 等. 2008-2021年咸宁市肺结核病患者就诊延迟及影响因素分析[J]. 公共卫生与预防医学,2023,34(3):74–78. DOI:10.3969/j.issn.1006−2483.2023.03.016.Liu KY, Xu Q, Ge MC, et al. Treatment delay and influencing factors of tuberculosis patients in Xianning from 2008 to 2021[J]. J Pub Health Prev Med, 2023, 34(3): 74–78. DOI: 10.3969/j.issn.1006−2483.2023.03.016. [13] 邱倩文. 2005-2020年广州番禺区肺结核流行趋势预测及就诊延迟影响因素研究[D]. 广州: 暨南大学, 2021. DOI: 10.27167/d.cnki.gjinu.2021.000945.Qiu QW. Epidemic trend prediction of tuberculosis and influencing factors of delay in medical treatment in Panyu district, Guangzhou from 2005 to 2020[D]. Guangzhou: Ji'nan University, 2021. DOI: 10.27167/d.cnki.gjinu.2021.000945. [14] Chimbatata NBW, Zhou C, Chimbatata CM, et al. Barriers to prompt TB diagnosis-a comparative study between northern Malawi and eastern rural China[J]. Trans R Soc Trop Med Hyg, 2017, 111(11): 504–511. DOI: 10.1093/trstmh/try002. [15] 徐静, 贺晓新, 周虹九, 等. 2011-2020年北京某市级定点医疗机构肺结核患者特征分析[J]. 首都公共卫生,2022,16(3):138–141. DOI: 10.16760/j.cnki.sdggws.2022.03.001.Xu J, He XX, Zhou HJ, et al. Characteristics of pulmonary tuberculosis patients in a municipal designated medical institution of Beijing, 2011–2020[J]. Cap J Publ Health, 2022, 16(3): 138–141. DOI: 10.16760/j.cnki.sdggws.2022.03.001. [16] 陈代权, 林淑芳, 周银发, 等. 2010-2019年福建省结核病患者就诊延迟及影响因素分析[J]. 中国防痨杂志,2023,45(1):96–103. DOI:10.19982/j.issn.1000−6621.20220294.Chen DQ, Lin SF, Zhou YF, et al. Patient delay and related factors among tuberculosis patient in Fujian province 2010–2019[J]. Chin J Antituberc, 2023, 45(1): 96–103. DOI: 10.19982/j.issn.1000−6 621.20220294. [17] 李静, 姜游力, 陈敬芳, 等. 结核病患者就诊延迟现状调查及影响因素分析[J]. 热带医学杂志,2022,22(11):1601–1604. DOI:10.3969/j.issn.1672−3619.2022.11.030.Li J, Jiang YL, Chen JF, et al. Investigation on delayed treatment of tuberculosis patients and analysis of influencing factors[J]. J Trop Med, 2022, 22(11): 1601–1604. DOI: 10.3969/j.issn.1672− 3619.2022.11.030. [18] 沈鸿程, 杜雨华, 张广川, 等. 2008-2018年广州市结核病患者就诊延迟影响因素分析[J]. 中国防痨杂志,2020,42(5):510–517. DOI:10.3969/j.issn.1000−6621.2020.05.017.Shen HC, Du YH, Zhang GC, et al. Influencing factors of pulmonary tuberculosis patient delay in Guangzhou, 2008–2018[J]. Chin J Antituberc, 2020, 42(5): 510–517. DOI: 10.3969/j.issn.1000−6621.2020.05.017. [19] 俞南, 魏云芳. 2014-2020年北京市朝阳区肺结核病患者就诊延迟情况及影响因素分析[J]. 疾病监测,2022,37(1):92–96. DOI: 10.3784/jbjc.202107270417.Yu N, Wei YF. Medical care seeking delay and related factors in pulmonary tuberculosis patients in Chaoyang district, Beijing, 2014–2020[J]. Dis Surveill, 2022, 37(1): 92–96. DOI: 10.3784/jbjc.202107270417. [20] 张思源, 黄飞, 汪彦辉, 等. 家庭收入与新发涂阳肺结核诊治延迟的关系[J]. 南京医科大学学报(社会科学版),2015,15(1):39–42. DOI: 10.7655/NYDXBSS20150110.Zhang SY, Huang F, Wang YH, et al. Impact of family income on delays of newly smear positive tuberculosis patients[J]. Acta Univ Med Nanjing ( Soc Sci), 2015, 15(1): 39–42. DOI: 10.7655/NYDXBSS20150110. [21] 景睿, 王美花, 王晓婷, 等. 济南市肺结核患者就医延迟影响因素分析[J]. 社区医学杂志,2019,17(14):823–826. DOI: 10.19790/j.cnki.JCM.2019.14.03.Jing R, Wang MH, Wang XT, et al. Analysis of influencing factors of patient delay among tuberculosis patients in Ji'nan city[J]. J Community Med, 2019, 17(14): 823–826. DOI: 10.19790/j.cnki.JCM.2019.14.03. [22] Tong YQ, Guan XH, Hou SY, et al. Determinants of health care-seeking delay among tuberculosis patients in rural area of central China[J]. Int J Environ Res Public Health, 2018, 15(9): 1998. DOI: 10.3390/ijerph15091998. [23] 王芸, 方世林, 禄晓龙, 等. 中国结核病患者三类延迟现况及其与经济因素关联的Meta分析[J]. 中国循证医学杂志,2022,22(7):791–798. DOI:10.7507/1672−2531.202112089.Wang Y, Fang SL, Lu XL, et al. Three types of delay among tuberculosis patients in China and their associations with economic factors: a meta-analysis[J]. Chin J Evid-Base Med, 2022, 22(7): 791–798. DOI: 10.7507/1672−2531.202112089. [24] 唐南, 许琳. 云南省2005年与2013年涂阳肺结核患者就诊延迟变化分析[J]. 公共卫生与预防医学,2015,26(2):20–23.Tang N, Xu L. Comparison of the patients with delayed treatment among smear positive TB patients in Yunnan province between 2005 and 2013[J]. J Pub Health Prev Med, 2015, 26(2): 20–23. [25] Wondawek TM, Ali MM. Delay in treatment seeking and associated factors among suspected pulmonary tuberculosis patients in public health facilities of Adama town, eastern Ethiopia[J]. BMC Public Health, 2019, 19(1): 1527. DOI: 10.1186/s12889−019−7886−7. [26] 周玉兰, 邓亚利, 冉建朝, 等. 2008-2017年新疆生产建设兵团肺结核患者就诊、确诊延迟及影响因素分析[J]. 现代预防医学,2018,45(16):3014–3018.Zhou YL, Deng YL, Ran JC, et al. Analysis of the treatment delay, diagnosis delay and influencing factors of tuberculosis patients in Xinjiang production and construction corps from 2008 to 2017[J]. Mod Prev Med, 2018, 45(16): 3014–3018. [27] Zhang L, Weng TP, Wang HY, et al. Patient pathway analysis of tuberculosis diagnostic delay: a multicentre retrospective cohort study in China[J]. Clin Microbiol Infect, 2021, 27(7): 1000–1006. DOI: 10.1016/j.cmi.2020.12.031. [28] Chen HG, Wang TW, Cheng QX. Gender and time delays in diagnosis of pulmonary tuberculosis: a cross-sectional study from China[J]. Epidemiol Infect, 2019, 147: e94. DOI: 10.1017/s0950268819000049. [29] Li T, Zhang H, Shewade HD, et al. Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China[J]. BMC Health Serv Res, 2018, 18(1): 786. DOI: 10.1186/s12913−018−3583−y. [30] 赵颖, 罗兴能, 李廷荣, 等. 重庆市沙坪坝区肺结核病患者确诊延迟的病例对照研究[J]. 中国社会医学杂志,2014,31(1):61–63. DOI:10.3969/j.issn.1673−5625.2014.01.023.Zhao Y, Luo XN, Li TR, et al. A case-control study on diagnostic delay of PTB patients in shapingba distric of Chongqing[J]. Chin J Social Med, 2014, 31(1): 61–63. DOI: 10.3969/j.issn.1673− 5625.2014.01.023. [31] 姜游力, 张培泽, 邓国防, 等. 结核病患者诊断延迟及其影响因素研究进展[J]. 结核与肺部疾病杂志,2021,2(3):289–293. DOI:10.3969/j.issn.2096−8493.20210073.Jiang YL, Zhang PZ, Deng GF, et al. Research progress of delay in diagnosis of tuberculosis and its influencing factors[J]. J Tuberc Lung Dis, 2021, 2(3): 289–293. DOI: 10.3969/j.issn.2096−8493.20210073. -

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