Key Laboratory of Medical Molecular Virology, Institute of Biomedical Sciences and Institute of Medical Microbiology, Fudan University, Shanghai, PR China.
Eur J Public Health. 2013 Apr;23(2):253-7. doi: 10.1093/eurpub/cks037. Epub 2012 Aug 8.
Delays in the diagnosis of tuberculosis reflect a lack of access to care, and contribute to ongoing tuberculosis transmission in the community. The objective of this study was to evaluate the delay in tuberculosis testing and the associated risk factors in Shanghai, Shandong and Sichuan provinces in China.
A prospective cohort study of 765 culture-positive pulmonary tuberculosis patients registered between December 2006 and December 2008. The delay between the onset of symptoms and tuberculosis diagnosis testing and patient information were recorded in a questionnaire and analysed.
The median delay was 36 days and was significantly shorter in patients from Shanghai compared with other places (30 vs. 42 days, P < 0.001). Multivariate analysis revealed that cough in Shanghai patients, lowest income level, being married and presenting expectoration in Shandong and Sichuan patients, were associated with a delay in the diagnosis testing of tuberculosis of >30 days. The only factor associated with a delay of >90 days was, in Shandong and Sichuan provinces only, female gender. The presence of other pulmonary symptoms like haemoptysis and loss of weight, fever and chills could shorten these delays.
Efforts to shorten delays in the diagnosis of tuberculosis must target vulnerable populations. The non-specific symptom of cough is a risk factor associated with longer delays. Training for healthcare workers in areas with a high incidence of tuberculosis, where a delayed diagnosis in coughers may enhance tuberculosis transmission in the community, is of paramount importance.
结核病诊断的延误反映了获得医疗服务的机会不足，并导致社区中结核病的持续传播。本研究的目的是评估中国上海、山东和四川三省结核病检测的延迟及其相关的危险因素。
对 2006 年 12 月至 2008 年 12 月登记的 765 例培养阳性肺结核患者进行前瞻性队列研究。在问卷中记录了症状出现和结核病诊断检测之间的延迟以及患者信息，并进行了分析。
中位延迟时间为 36 天，上海患者的延迟时间明显短于其他地区（30 天比 42 天，P<0.001）。多变量分析显示，上海患者的咳嗽、最低收入水平、已婚状况以及山东和四川患者的咳痰与结核病诊断检测的延迟超过 30 天有关。唯一与延迟超过 90 天有关的因素是，仅在山东和四川两省，女性性别。其他肺部症状如咯血、体重减轻、发热和寒战的存在可以缩短这些延迟。
缩短结核病诊断的延迟必须针对弱势群体。咳嗽这一非特异性症状是与较长延迟相关的危险因素。在结核病高发地区，对卫生保健工作者进行培训非常重要，因为在咳嗽者中延迟诊断可能会增强社区中的结核病传播。
