Medical facility visit and diagnosis delays of tuberculosis patients in Gansu based on surveillance during 2016–2022

Objective To analyze the consultation and diagnostic delays of tuberculosis (TB) patients and influencing factors in Gansu province from 2016 to 2022, and provide scientific basis for formulating and adjusting TB prevention and treatment measures.

Methods The information of 50 606 TB patients diagnosed in Gansu between 2016 and 2022 were collected from National Tuberculosis Information Management System, and the possible influencing factors of medical facility visit and diagnosis delays were analyzed by using the one-way χ² test and multivariate logistic regression.

Results In the 50 606 TB patients reported in Gansu during 2016−2022, the average interval between the first onset of symptoms and the medical facility visit was 64.44 days, and only 27.86% of the patients saw doctors within 14 days. The average interval between the first medical facility visit and the diagnosis was 6.88 days, and 91.12% of patients were diagnosed within 14 days. Compared with the patients who visited medical facilities within 7 days, more patients visited medical facilities within 7−14 days, 15−30 days and 31-60 days in age group 19～45 years compared with age group ＞60 years (OR=1.16, 95%CI: 1.07–1.26; OR=1.24, 95%CI: 1.16–1.33; OR=1.29, 95%CI: 1.20–1.38). In these patients, being newly detected TB patient was the risk factor for medical facility visit delay (OR=1.25, 95%CI: 1.02−1.52; OR=1.55, 95%CI: 1.28–1.86; OR=1.65, 95%CI: 1.37−1.98), and being TB patient detected in health screening was the protective factor for medical facility visit delay (OR=0.65, 95%CI: 0.47–0.89; OR=0.30, 95%CI: 0.21–0.44; OR=0.30, 95%CI: 0.20–0.45). The patients aged >60 years had the highest hazard ratio for diagnosis delay in all age groups. The patients in Han ethnic group had less diagnosis delays compared with the patients in minor ethnic group (OR=0.88, 95%CI: 0.78–0.98; OR=0.88, 95%CI: 0.68–0.91; OR=0.59, 95%CI: 0.49−0.71; OR=0.66, 95%CI: 0.52−0.84); and in the patients from different sources, the risk factors for diagnosis delay included follow-up (OR=1.59, 95%CI: 1.28−1.97; OR=2.49, 95%CI: 1.83−3.40; OR=2.44, 95%CI: 1.64−3.62) and health examination (OR=2.55, 95%CI: 1.76−3.69; OR=2.17, 95%CI: 1.22−3.85; and OR=2.13, 95%CI: 1.27−3.12) for those diagnosed within 15−30 days, 31−60 days, and more than 60 days. The patients diagnosed within 15−30 days and 31～60 days in local population had lower probability of delayed diagnosis compared with those in floating population (OR=0.73, 95%CI: 0.62–0.87; OR=0.74, 95%CI: 0.65–0.84), and the differences were all significant (P<0.05).

Conclusion The incidence of medical facility visit and diagnosis delay in TB patients was high in Gansu, and there is a long way to go to end the delays in TB diagnosis and treatment. While strengthening health education about TB prevention and control, it is more important for medical personnel to improve the diagnosis of TB to effectively reduce the incidence of diagnosis delay.