Díez M, Bleda M J, Alcaide J, Castells C, Cardenal J I, Domínguez A, Gayoso P, Guitiérrez G, Huerta C, López M J, Moreno T, Muñoz F, García-Fulgueiras A, Picó M, Pozo F, Quirós J R, Robles F, Sánchez J M, Vanaclocha H, Vega T
TB Research Unit, National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain.
Eur J Public Health. 2005 Aug;15(4):343-9. doi: 10.1093/eurpub/cki010. Epub 2005 Jul 13.
Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients.
Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables.
A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged.
Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.
卫生系统延误（HSD）是结核病（TB）控制中的一个重要问题。本报告调查了一组西班牙文化确诊结核病患者中的卫生系统延误情况及相关因素。
从临床记录中收集数据。使用逻辑回归，以两个不同的截止点来定义卫生系统延误（中位数和第75百分位数），调整后的优势比用于估计卫生系统延误与不同变量之间的关联。
共纳入5184例文化确诊结核病病例。卫生系统延误的中位数和第75百分位数分别为6天和25天。显著高于中位数的卫生系统延误与以下因素相关：年龄>44岁、过去或现在使用静脉注射药物、在初级保健中心确诊、先前的预防性治疗、组织学阳性、进行药敏试验的请求、除结核病外存在矽肺或肿瘤、存在非结核病相关症状以及胃肠道部位。高于第75百分位数的卫生系统延误与相同变量相关，但初级保健中心确诊、组织学阳性、矽肺、非结核病相关症状和胃肠道部位除外，这些因素的关联消失；相反，与女性性别出现关联。
尽管西班牙普遍提供免费医疗保健，但仍有一些结核病患者群体的治疗被过度延迟。
