Variables associated with diagnostic delay in immigrant groups with tuberculosis in Madrid.

OBJECTIVE

To identify variables associated with total diagnostic delay (TDD), patient delay (PD) and health service delay (HSD), among the tuberculous immigrant population in the Autonomous Community of Madrid (ACT).

METHODOLOGY

Tuberculosis cases diagnosed in 15 hospitals in the ACT in 2003 were interviewed face-to-face and medical records were reviewed. A descriptive study was conducted, followed by univariate and multivariate analysis using non-conditional logistic regressions. 50th (p50) and 75th (p75) percentiles of the different diagnostic delay components were analysed as dependent variables.

RESULTS

For the 296 cases included, the mean TDD was 40.5 days (IQR 16.0-90.0), the PD was 15 days (IQR 6.5-30.0), and the HSD was 5 days (IQR 0.0-30.0). TDD-p75 is associated with seeking primary health care (OR 2.87, 95%CI 1.47-5.58). PD-p75 is associated with identification of fever (OR 0.49, 95%CI 0.25-0.92) and non-identification of cough (OR 1.87, 95%CI 1.05-3.36) as symptoms resulting in health care being sought. The HSD-p75 is associated with primary health care being sought (OR 3.81, 95%CI 1.87-7.78), health cover (OR 15.07, 95%CI 1.96-115.68) and negative smear results at the time of diagnosis (OR 1.98, 95%CI 1.01-3.91).

CONCLUSIONS

The HSD needs to be reduced, mainly when health care is sought through the primary care services and among patients with negative smear results.