ANTICPE, INSERM U1086, Caen, France.
Field Service, South East and London, Public Health England, London, UK.
BMJ Open Respir Res. 2019 Oct 15;6(1):e000468. doi: 10.1136/bmjresp-2019-000468. eCollection 2019.
A quarter of London's pulmonary tuberculosis (TB) patients have over 4 months of delay. Late diagnosis increases disease severity and the risk of transmission. We aim to classify delays, identify associated risk factors and assess treatment outcome.
We conducted a retrospective cohort study using London surveillance data, 2012-2018 on adults aged ≥18 years with pulmonary TB. We defined presentation delay (days from symptom onset to first healthcare visit) and healthcare delay (first healthcare visit to treatment commencement) as dichotomous variables; positive delay being days equal or greater than the third quartile. We applied logistic regression models to identify risk factors associated with delays and treatment outcome at 12 months.
Of 7216 people, 4539 reported presentation and 5193 healthcare delays. The third quartiles for presentation and healthcare delay were 84 and 61 days, respectively. Presentation delay was associated with female sex (adjusted OR (aOR)=1.21; 95% CI 1.04 to 1.39), increasing age (aOR=1.004; 95% CI 1.001 to 1.008), white compared to Asian ethnicity (aOR=1.35; 95% CI 1.12 to 1.62), previous imprisonment (aOR=1.66; 95% CI 1.22 to 2.26) and alcohol misuse (aOR=1.44; 95% CI 1.04 to 1.89). Healthcare delay was associated with female sex (aOR=1.39; 95% CI 1.21 to 1.59), increasing age (aOR=1.014; 95% CI 1.009 to 1.018) and white ethnicity (aOR=1.41; 95% CI 1.19 to 1.68). 16% of 5678 people with known outcome did not complete treatment. Neither delay was associated with non-completion (p value <0.05).
Female, white and older people with TB were more likely to experience both presentation and healthcare delays. Social risk factors were also associated with delay in presentation. Early diagnosis and treatment remain critical to reduce transmission, regardless of whether delay affected completion.
四分之一的伦敦肺结核（TB）患者有超过 4 个月的延误。延迟诊断会增加疾病的严重程度和传播风险。我们旨在对延误进行分类，确定相关的危险因素，并评估治疗结果。
我们使用伦敦监测数据进行了一项回顾性队列研究，纳入了 2012 年至 2018 年年龄在 18 岁及以上的患有肺结核的成年人。我们将就诊延误（从症状出现到首次就诊的天数）和医疗保健延误（首次就诊到开始治疗的天数）定义为二分类变量；阳性延误定义为等于或大于第三四分位数的天数。我们应用逻辑回归模型来确定与延误和 12 个月时治疗结果相关的危险因素。
在 7216 人中，4539 人报告了就诊延误，5193 人报告了医疗保健延误。就诊延误和医疗保健延误的第三四分位数分别为 84 天和 61 天。就诊延误与女性（调整后的比值比（aOR）=1.21；95%可信区间 1.04 至 1.39）、年龄增长（aOR=1.004；95%可信区间 1.001 至 1.008）、白种人而非亚洲人种（aOR=1.35；95%可信区间 1.12 至 1.62）、既往监禁（aOR=1.66；95%可信区间 1.22 至 2.26）和酒精滥用（aOR=1.44；95%可信区间 1.04 至 1.89）有关。医疗保健延误与女性（aOR=1.39；95%可信区间 1.21 至 1.59）、年龄增长（aOR=1.014；95%可信区间 1.009 至 1.018）和白种人（aOR=1.41；95%可信区间 1.19 至 1.68）有关。在已知结局的 5678 人中，有 16%的人未完成治疗。无论哪种延误都与未完成治疗无关（p 值<0.05）。
患有肺结核的女性、白种人和老年人更有可能出现就诊和医疗保健延误。社会危险因素也与就诊延误有关。早期诊断和治疗仍然至关重要，以减少传播，无论延误是否影响治疗完成。
