摘要
目的了解我国2020年西部地区肺结核患者的就诊及诊断延迟情况,分析肺结核患者就诊及诊断延迟的影响因素,为我国西部地区肺结核防治政策的制定提供参考依据。方法本研究为横断面调查,采用整群抽样的方法选取我国西部12个省份的16家结核病定点医疗机构,2020年10—12月对其中在治且治疗时间大于2周的药物敏感肺结核患者进行面对面问卷调查,调查内容包括患者的基本信息、诊疗信息等。对患者人口学特征、就诊延迟及诊断延迟情况等进行描述性分析,采用χ^(2)检验进行单因素分析,采用多因素logistic回归分析结核病患者就诊延迟和诊断延迟的影响因素。结果本研究共调查1030例肺结核患者,其中纳入就诊延迟分析856例;纳入诊断延迟分析987例。结果显示,2020年我国西部地区肺结核患者就诊时间中位数为9(3,35)d,就诊延迟发生率为41.24%(353/856),初治[比值比(OR)=2.183,95%置信区间(CI):1.172~4.064]、患有其他慢性病(OR=1.551,95%CI:1.152~2.088)为肺结核患者发生就诊延迟的危险因素;家庭年收入≥40000元(40000~元:OR=0.252,95%CI:0.169~0.376;≥60000元:OR=0.258,95%CI:0.170~0.391)为肺结核患者就诊延迟的保护因素。我国西部地区肺结核患者诊断时间中位数为12(3,33)d,诊断延迟率为44.48%(439/987),年龄≥65岁(OR=2.508,95%CI:1.679~3.747)、农村(OR=2.479,95%CI:1.798~3.419)、流动人口(OR=4.347,95%CI:1.355~13.945)为肺结核患者诊断延迟危险因素;采用分子生物学方式诊断结核病(OR=0.499,95%CI:0.312~0.796)为患者诊断延迟的保护因素。结论我国西部地区结核病患者的就诊延迟和诊断延迟现象均较为普遍,建议针对重点人群,加强结核病宣传教育,提高基层医疗机构结核病诊疗水平,从而避免肺结核患者就诊及诊断延迟的发生。
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 1030 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 usedχ^(2)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 1030 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>40000 yuan(40000–yuan:OR=0.252,95%CI:0.169–0.376;≥60000 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.
作者
郝冬青
李涛
徐彩红
Hao Dongqing;Li Tao;Xu Caihong(National Center for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)
出处
《疾病监测》
CAS
CSCD
北大核心
2023年第11期1294-1300,共7页
Disease Surveillance
基金
中央财政结核病控制项目结核业务日常运转(No.232811)。
关键词
结核
肺
就诊延迟
诊断延迟
影响因素
Tuberculosis
Pulmonary
Health-care seeking delay
Diagnosis delay
Influencing factor
作者简介
郝冬青,男,山东省烟台市人,在读硕士研究生,从事结核病经济学研究,ORCID:0009−0006−5877−3665,Email:haodongqing1204@163.com;通信作者:徐彩红,Tel:010-58900535,Email:xuch@chinacdc.cn。
