Influencing factors associated with health-care seeking delay and diagnosis delay of pulmonary tuberculosis patients in western China, 2020

  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.