2015－2020年贵州省本地与外地肺结核患者就诊延迟特征及影响因素分析

王秉萍; 赵茜; 杨敬源; 李进岚; 陈玮

doi:10.3784/jbjc.202202280074

2015－2020年贵州省本地与外地肺结核患者就诊延迟特征及影响因素分析

Health-care seeking delay among local and nonlocal pulmonary tuberculosis patients and its influencing factors in Guizhou, 2015−2020

摘要

摘要:
目的描述2015—2020年贵州省本地与外地肺结核患者就诊延迟特征并分析其影响因素，为贵州省结核防控提供依据。
方法从“结核病信息管理系统”中收集2015—2020年确诊为肺结核患者的病案信息，就诊延迟影响因素的分析采用χ²检验和logistic回归模型。
结果 2015—2020年贵州省肺结核患者总体、本地与外地肺结核患者就诊延迟率分别为65.14%、64.72%和65.55%，均呈下降趋势（趋势χ²_总体=334.604，趋势χ²_本地=224.600，趋势χ²_外地=139.364，均P<0.001）。地区分布本地（75.20%）与外地（70.80%）患者就诊延迟率均以铜仁市最高。多因素分析结果显示，女性（OR_本地=1.024，OR_外地=1.012）、高龄［30～44岁组（OR_本地=1.056，OR_外地=1.077）、45～59岁组（OR_本地=1.211，OR_外地=1.287）、≥ 60岁组（OR_本地=1.289，OR_外地=1.334）］、非农民［学生（OR_本地=0.744，OR_外地=0.694）、工人（OR_本地=0.744，OR_外地=0.505）、待业（OR_本地=0.809，OR_外地=0.788）］、被动发现方式［追踪（OR_本地=3.772，OR_外地=3.319）、转诊（OR_本地=3.233，OR_外地=2.266）、因症就诊（OR_本地=4.626，OR_外地=3.042）、因症推荐（OR_本地=2.995，OR_外地=3.195）］、重症患者（OR_本地=1.134，OR_外地=1.120）是本地与外地肺结核患者发生就诊延迟的共同危险因素。
结论 2015—2020年贵州省本地与外地肺结核患者就诊延迟率均处较高水平，应针对重点地区和重点人群采取综合措施进一步改善就诊延迟情况。

Abstract:
Objective To describe the characteristics of the health-care seeking delay in local and nonlocal pulmonary tuberculosis (TB) patients in Guizhou province from 2015 to 2020, analyze the influencing factors and provide evidence for the prevention and control of pulmonary TB in Guizhou.
Methods The medical record information of patients diagnosed with pulmonary TB in Guizhou between 2015 and 2020 were collected from “Tuberculosis Information Management System”, and the factors influencing the health-care seeking delay were analyzed by using χ² test and Logistic regression model.
Results From 2015 to 2020, the overall health-care seeking delay rate of pulmonary TB patients was 65.14% in Guizhou, and the health-care seeking delay rates in local and nonlocal pulmonary TB patients were 64.72% and 65.55%, respectively, all showing a downward trend (trend χ²_overall=334.604, χ²_local=224.600, χ²_nonlocal=139.364, P<0.001). The health-care seeking delay rates were highest in both local (75.20%) and nonlocal (70.80%) patients in Tongren. The results of multivariate analysis showed that being woman (OR_local=1.024, OR_nonlocal=1.012), being aged 30–44 years (OR_local=1.056, OR_nonlocal=1.077), being aged 45–59 years (OR_local=1.211, OR_nonlocal=1.287), being aged ≥60 years (OR_local=1.289, OR_nonlocal=1.334), non-farmers (being student (OR_local=0.744, OR_nonlocal=0.694), being worker (OR_local=0.744, OR_nonlocal=0.505), being unemployed (OR_local=0.809), OR_nonlocal=0.788), passive detection (OR_local=3.772, OR_nonlocal=3.319), referral (OR_local=3.233, OR_nonlocal=2.266), seeking medical care due to symptoms (OR_local=4.626, OR_nonlocal=3.042), symptom based referral (OR_local=2.995, OR_migrated=3.195), and being severe patients (OR_local=1.134, OR_migrated=1.120) were the common risk factors for the health-care seeking delay in both local and nonlocal pulmonary TB patient in Guizhou.
Conclusion From 2015 to 2020, the delay rates in local and nonlocal pulmonary TB patients in Guizhou were relatively high. Comprehensive measures should be taken to further improve the health-care seeking in key areas and key populations.

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