Analysis on medical care seeking delay in pulmonary tuberculosis patients and influencing factors in Chongqing metropolitan area, 2016−2022

Objective To describe the characteristics of delayed medical care seeking in pulmonary tuberculosis (TB) patients and influencing factors in Chongqing metropolitan area, which covers Chongqing municipality and Guang'an prefecture of Sichuan province, from 2016 to 2022, and provide evidence for pulmonary TB prevention and control in this area.

Methods The medical records data of drug sensitive pulmonary TB patients registered in Chongqing and Guang 'an during 2016−2022, including age, gender, occupation, patient source, complication, treatment type, current address, onset date, the first medical care seeking date, registration date, household registration type, key population and area bring diagnosed, were extracted from the Tuberculosis Information Management System, a subsystem of China Disease Prevention and Control Information System. The median and interquartile intervals were used for statistical description. The trend in medical care seeking delay over time was analyzed with χ² test. The influencing factors for medical care seeking delay were analyzed with χ² test and Logistic regression model.

Results The median delay of medical care seeking was 29 (9,62) days in pulmonary TB patients in Chongqing metropolitan area from 2016 to 2022, and the average annual delay rate was 67.11% (81070/120807), and the delay rate showed a decreasing trend year by year (trend χ² = 244.650, P < 0.01). The delay rates were much higher in northeast Chongqing (73.98%) and southeast Chongqing (70.72%) than in others (χ²=1877.018, P<0.001). Being resident from other area odds ratio（OR）=1.08, 95% confidence interval (CI): 1.04–1.12, passive detection (OR=5.56, 95%CI: 5.07–6.11), comorbidity (OR=1.13, 95%CI: 1.10–1.16), age 26–39 years (OR=1.14, 95%CI: 1.08–1.20), age 40–54 years (OR=1.42, 95%CI: 1.35–1.49, age 55–64 years (OR=1.50, 95%CI: 1.41–1.59, age ≥65 years (OR=1.38, 95%CI: 1.31–1.47, being in key population (OR=0.94, 95%CI: 0.90–0.98, occupation student (OR=0.56, 95%CI: 0.53–0.60), workers (OR=0.88, 95%CI: 0.83–0.94), unemployment or jobless (OR=0.83, 95%CI: 0.80–0.87), being retirees (OR=0.86, 95%CI: 0.81–0.92) and others (OR=0.65, 95%CI: 0.62–0.68) were the factors for medical care seeking delay.

Conclusion The delayed rate of medical care seeking in pulmonary TB patients in Chongqing metropolitan area decreased year by year, but the delay days and delay rate varied due to the different medical service level and accessibility, economic and transportation status and pulmonary TB incidence level in this area. Household registration status, patient source, comorbidity, age, key population and occupation were all the factors affecting the timeliness of medical care seeking of pulmonary TB patients, indicating targeted intervention measures should be taken.