Farah Mohamed Guled, Rygh Jens Henning, Steen Tore W, Selmer Randi, Heldal Einar, Bjune Gunnar
Norwegian Institute of Public Health, Oslo, Norway.
BMC Infect Dis. 2006 Feb 24;6:33. doi: 10.1186/1471-2334-6-33.
Delay in start of tuberculosis (TB) treatment has an impact at both the individual level, by increasing the risk of morbidity and mortality, and at the community level, by increasing the risk of transmission. The aims of this study were to assess the delays in the start of treatment for TB patients in Oslo/Akershus region, Norway and to analyze risk factors for the delays.
This study was based on information from the National TB Registry, clinical case notes from hospitals and referral case notes from primary health care providers. Delays were divided into patient, health care system and total delays. The association with sex, birthplace, site of the disease and age group was analyzed by multiple linear regression.
Among the 83 TB patients included in this study, 71 (86%) were born abroad. The median patient, health care system and total delays were 28, 33 and 63 days respectively, with a range of 1-434 days. In unadjusted analysis, patient delay and health care system delay did not vary significantly between men and women, according to birthplace or age group. Patients with extra-pulmonary TB had a significantly longer patient, health care system and total delay compared to patients with pulmonary TB. Median total delay was 81 and 56 days in the two groups of TB patients respectively. The health care system delay exceeded the patient delay for those born in Norway. The age group 60+ years had significantly shorter patient delay than the reference group aged 15-29 years when adjusted for multiple covariates. Also, in the multivariate analysis patients born in Norway had significantly longer health care system delay than patients born abroad.
A high proportion of patients had total delays in start of TB treatment exceeding two months. This study emphasizes the need of awareness of TB in the general population and among health personnel. Extra-pulmonary TB should be considered as a differential diagnosis in unresolved cases, especially for immigrants from high TB prevalence countries.
结核病（TB）治疗开始延迟在个体层面会增加发病和死亡风险，在社区层面会增加传播风险。本研究的目的是评估挪威奥斯陆/阿克什胡斯地区结核病患者治疗开始的延迟情况，并分析延迟的风险因素。
本研究基于国家结核病登记处的信息、医院的临床病例记录以及初级卫生保健提供者的转诊病例记录。延迟分为患者延迟、卫生保健系统延迟和总延迟。通过多元线性回归分析与性别、出生地、疾病部位和年龄组的关联。
本研究纳入的83例结核病患者中，71例（86%）出生在国外。患者延迟、卫生保健系统延迟和总延迟的中位数分别为28天、33天和63天，范围为1 - 434天。在未调整分析中，患者延迟和卫生保健系统延迟在男性和女性之间、根据出生地或年龄组并无显著差异。肺外结核病患者的患者延迟、卫生保健系统延迟和总延迟显著长于肺结核患者。两组结核病患者的总延迟中位数分别为81天和56天。对于出生在挪威的患者，卫生保健系统延迟超过了患者延迟。在调整多个协变量后，60岁及以上年龄组的患者延迟显著短于15 - 29岁的参照组。此外，在多变量分析中，出生在挪威的患者的卫生保健系统延迟显著长于出生在国外的患者。
很大一部分患者结核病治疗开始的总延迟超过两个月。本研究强调普通人群和卫生人员需要提高对结核病的认识。对于未确诊的病例，尤其是来自结核病高流行国家的移民，应将肺外结核病作为鉴别诊断。
