Lin Hui-Ping, Deng Chung-Yeh, Chou Pesus
Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, Republic of China.
BMC Public Health. 2009 Feb 12;9:55. doi: 10.1186/1471-2458-9-55.
The tuberculosis reporting enquiry system was launched in Taiwan in 2001. Tuberculosis has been categorized as the third most important notifiable disease in Taiwan and the time required for reporting has been shortened to 7 days.
A total of 114,827 cases were reported using the Taiwan enquiry system between 2002 and 2006; of these, 26,027 (22.7%) were finally diagnosed as not being tuberculosis, 7,005 (8.2%) were diagnosed as extra-pulmonary tuberculosis and 3,677 (3.2%) were not a first-time diagnosis of tuberculosis, and these cases were hence excluded. Diagnosis time was defined as the length of time between the first medical examination (including chest radiography, sputum smear or sputum culture) to the diagnosis of PTB; treatment time was defined as the period from the diagnosis of PTB to the initiation of treatment. Using the cut-off at the 75th percentile, a period of longer than 9 days was defined as a diagnosis delay and a period of longer than 2 days as a treatment delay. Multiple logistic regression analysis was applied to analyze the risk factors associated with these delays.
During the five-year study period, among the 78,118 new PTB patients reported in Taiwan, the mean diagnosis and treatment times were 12 and 5 days and the median times 1 day and 0 days, respectively. In total, 24.9% of the new PTB patients' diagnosis time delays were longer than 9 days and 20.3% of the patients' treatment time delays were longer than 2 days. The main factors associated with diagnosis delay included age, reporting year, living with family and a positive sputum culture (p < 0.0001); the risk factors significantly associated with treatment delay were increased age, an aboriginal ethnic background, a positive sputum culture and diagnosis at a non-medical center (p < 0.0001).
The Taiwan TB reporting enquiry system has successfully increased the confirmed PTB reporting rate from 64.4% to 71.5%. Greater age and a positive sputum culture were both found to significantly increase both diagnosis and treatment delays; treatment delay is also significantly affected by the patient having an aboriginal ethnic background and being diagnosed at a non-medical center.
台湾于2001年启动结核病报告查询系统。结核病已被列为台湾第三大法定传染病，报告所需时间已缩短至7天。
2002年至2006年期间，台湾查询系统共报告了114,827例病例；其中，26,027例（22.7%）最终被诊断为非结核病，7,005例（8.2%）被诊断为肺外结核病，3,677例（3.2%）并非初诊结核病，因此这些病例被排除。诊断时间定义为首次医学检查（包括胸部X光、痰涂片或痰培养）至确诊肺结核的时长；治疗时间定义为确诊肺结核至开始治疗的时长。以第75百分位数为界值，超过9天的时长定义为诊断延迟，超过2天的时长定义为治疗延迟。采用多因素logistic回归分析来分析与这些延迟相关的危险因素。
在为期五年的研究期间，台湾报告的78,118例新肺结核患者中，诊断和治疗的平均时间分别为12天和5天，中位数时间分别为1天和0天。总共有24.9%的新肺结核患者诊断时间延迟超过9天，20.3%的患者治疗时间延迟超过2天。与诊断延迟相关的主要因素包括年龄、报告年份、与家人同住以及痰培养阳性（p<0.0001）；与治疗延迟显著相关的危险因素包括年龄增加、原住民背景、痰培养阳性以及在非医疗中心确诊（p<0.0001）。
台湾结核病报告查询系统已成功将确诊肺结核报告率从64.4%提高至71.5%。研究发现，年龄较大和痰培养阳性均显著增加诊断和治疗延迟；患者的原住民背景以及在非医疗中心确诊也显著影响治疗延迟。
