Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
EPIUnit: Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
Pulmonology. 2019 Jul-Aug;25(4):215-222. doi: 10.1016/j.pulmoe.2019.02.005. Epub 2019 Mar 28.
Delayed diagnosis and treatment of tuberculosis contributes to the spread of the disease. In this study, we aimed to determine the patient and healthcare system delay among tuberculosis patients in Portugal and identify associated factors at individual and contextual level.
We analysed all TB cases notified in Portugal between 2010 and 2014 using data from the national surveillance system. Patient and healthcare system delay were computed, log-transformed, and used as outcomes. Adjusted generalized linear models were fitted to identify sociodemographic, contextual and clinical determinants.
The study included 6838 patients. The median of patient and healthcare system were 33 and 17 days, respectively. Adjusted regression models revealed that higher patient delay occurred in foreign patients (exponentiated beta: 1.177, 95%CI 1.091-1.270) and those addicted to alcohol (1.169, 1.072-1.276) and drugs (1.153, 1.027-1.295). Higher healthcare system delay was observed among patients with extra-pulmonary TB (2.067, 1.885-2.268) and pulmonary comorbidities - lung cancer (2.391, 1.656-3.452), sarcoidosis (3.316, 1.370-8.022) and COPD (1.295, 1.059-1.584) - and in patients residing further from a healthcare service (1.040, 1.018-1.062).
We found that various individual and contextual factors affect the time delay in tuberculosis treatment. Our findings indicate that some strategies, such as facilitating the access to healthcare services among foreign patients and patients with addictions and increasing the awareness towards TB among healthcare professionals, may result in better TB control.
结核病的诊断和治疗延误导致疾病的传播。本研究旨在确定葡萄牙结核病患者的患者和医疗系统延误，并确定个体和背景层面的相关因素。
我们使用国家监测系统的数据分析了 2010 年至 2014 年间在葡萄牙报告的所有结核病病例。计算并对数转换了患者和医疗系统的延迟，并将其作为结果进行分析。拟合了调整后的广义线性模型，以确定社会人口统计学、背景和临床决定因素。
本研究共纳入 6838 例患者。患者和医疗系统的中位数分别为 33 天和 17 天。调整后的回归模型显示，外国患者（指数β：1.177，95%CI 1.091-1.270）和酒精（1.169，1.072-1.276）和药物成瘾患者（1.153，1.027-1.295）的患者延迟更高。肺结核以外的患者（2.067，1.885-2.268）和肺合并症-肺癌（2.391，1.656-3.452）、结节病（3.316，1.370-8.022）和 COPD（1.295，1.059-1.584）的患者以及远离医疗服务的患者（1.040，1.018-1.062）的医疗系统延迟更高。
我们发现，各种个人和背景因素会影响结核病治疗的时间延迟。我们的研究结果表明，一些策略，如促进外国患者和成瘾患者获得医疗服务，提高医疗保健专业人员对结核病的认识，可能会导致更好的结核病控制。
