2015—2023年陕西省结核病患者就诊延迟趋势及影响因素分析

邓亚丽; 赵燕; 张宏伟

doi:10.3784/jbjc.202507080475

2015—2023年陕西省结核病患者就诊延迟趋势及影响因素分析

Health care seeking delay and influencing factors in tuberculosis patients in Shaanxi, 2015-2023

摘要

摘要:
目的分析2015—2023年陕西省登记结核病患者就诊延迟情况及影响因素，为制定结核病防治策略和防控措施提供依据。
方法收集 2015—2023年陕西省登记结核病患者的病案信息，采用Joinpoint 5.3.0软件分析就诊延迟率变化趋势，采用χ²检验进行单因素分析，采用二元 logistic 回归模型分析影响就诊延迟率的因素。
结果 2015—2023年陕西省登记结核病患者166 653例，其中就诊延迟87 621例，就诊延迟率为52.57%，就诊延迟天数中位数为15（4，39）d。2015—2023年就诊延迟率呈下降趋势平均年度变化百分比（AAPC）=−3.70%，P＜0.001）。二元logistic回归分析显示，女性（OR＝1.05，95%CI： 1.03～1.07）、年龄为45～<65岁（OR＝1.10，95%CI：1.06～1.13）和≥65岁（OR＝1.09，95%CI：1.05～1.13）、患者所在地区为陕北（OR=1.28，95%CI：1.24～1.31）和陕南（OR=1.54，95%CI：1.50～1.57）、患者来源为被动发现（OR=2.93，95%CI：2.16～3.98）、诊断类型为结核性胸膜炎（OR=1.08，95%CI：1.01～1.16）、病原学阴性（OR=1.20，95%CI：1.18～1.23）、无病原学结果（OR=1.17，95%CI：1.10～1.23）、复治患者（OR=1.10，95%CI：1.05～1.16）是就诊延迟的高危因素。职业为学生和儿童为影响就诊延迟的保护因素（OR＝0.77，95%CI：0.70～0.84）。
结论 2015—2023年陕西省结核病患者就诊延迟呈下降趋势，但是延迟率仍然比较高，应加强对居民的健康教育，提高主动就诊，加强结核病主动筛查，优化医疗服务质量，减少就诊延迟。

Abstract:
Objective To analyze health care seeking delay and influencing factors in registered tuberculosis (TB) patients in Shaanxi province from 2015 to 2023, and provide evidence for the development of TB prevention and control strategies.
Methods The information of registered TB patients in Shaanxi from 2015 to 2023 and the trend of health care seeking delay rate was analyzed by using Joinpoint 5.3.0. Univariate analysis was performed by using χ² test and influencing factors of health care seeking delay were analyzed using Binary logistic regression model.
Results During 2015−2023, a total of 166 653 TB cases were registered in Shaanxi, of which 87 621 had delayed health care seeking. The average rate of health care seeking delay was 52.57%, and the median delay was 15 (4, 39) days. There was a decreasing trend in the rate of health care seeking delay from 2015 to 2023 average annual percent change (AAPC) =− 3.70%, P<0.001. Binary logistic regression analysis showed that being woman (OR = 1.05, 95%CI: 1.03−1.07), age 45− <65 years (OR = 1.10, 95%CI: 1.06−1.13) and ≥65 years (OR = 1.09, 95%CI: 1.05−1.13), living in the northern Shaanxi (OR = 1.28, 95%CI: 1.24−1.31) and in southern Shaanxi (OR = 1.54, 95%CI: 1.50−1.57), passive detection (OR = 2.93, 95%CI: 2.16−3.98), tuberculous pleurisy (OR=1.08, 95%CI: 1.01−1.16), negative etiological detection (OR=1.20, 95%CI: 1.18 −1.23), and absence of etiological detection results (OR=1.17, 95%CI: 1.10−1.23), being retreated patients (OR=1.10, 95%CI:1.05−1.16) were the high−risk factors of health care seeking delay. Being students and children was the protective factor of health care seeking delay (OR = 0.77, 95%CI: 0.70−0.84).
Conclusion There was a decreasing trend in the rate of health care seeking delay in Shaanxi from 2015 to 2023, but the health care seeking delay is still relatively common in TB patients. It is necessary to take measures to reduce the rate of health care seeking delay, such as strengthened health education, improved active screening, and better healthcare services.

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