Department of Tuberculosis Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China.
Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, Hubei, China.
Front Public Health. 2023 Feb 20;11:1059433. doi: 10.3389/fpubh.2023.1059433. eCollection 2023.
To describe the trend of tuberculosis (TB) diagnosis in the migrant city Shenzhen, China, and analyze the risk factors of diagnosis delays.
Demographic and clinical information of TB patients from 2011 to 2020 in Shenzhen were extracted. A bundle of measures to enhance TB diagnosis had been implemented since late 2017. We calculated the proportions of patients who underwent a patient delay (>30 days from syndrome onset to first care-seeking) or a hospital delay (>4 days from first care-seeking to TB diagnosis). Multivariable logistic regression was used to analyze the risk factors of diagnosis delays.
During the study period, 43,846 patients with active pulmonary TB were diagnosed and registered in Shenzhen. On average, the bacteriological positivity rate of the patients was 54.9%, and this increased from 38.6% in 2017 to 74.2% in 2020. Overall, 30.3 and 31.1% of patients had a patient delay or a hospital delay, respectively. Molecular testing significantly increased bacteriological positivity and decreased the risk of hospital delay. People >35 years old, the unemployed, and residents had a higher risk of delays in both patient care-seeking and hospital diagnosis than younger people, workers, or migrants. Compared with passive case-finding, active case-finding significantly decreased the risk of patient delay by 5.47 (4.85-6.19) times.
The bacteriological positivity rate of TB patients in Shenzhen increased significantly but the diagnosis delays were still serious, which may need more attention when active case-finding in risk populations and optimization of molecular testing.
描述中国移民城市深圳的结核病（TB）诊断趋势，并分析诊断延迟的风险因素。
提取 2011 年至 2020 年深圳 TB 患者的人口统计学和临床信息。自 2017 年末以来，已经实施了一系列旨在增强 TB 诊断的措施。我们计算了患者延迟（从症状出现到首次就诊超过 30 天）或医院延迟（从首次就诊到 TB 诊断超过 4 天）的患者比例。多变量逻辑回归用于分析诊断延迟的风险因素。
在研究期间，深圳共诊断和登记了 43846 例活动性肺结核患者。平均而言，患者的细菌阳性率为 54.9%，从 2017 年的 38.6%增加到 2020 年的 74.2%。总体而言，分别有 30.3%和 31.1%的患者存在患者延迟或医院延迟。分子检测显著提高了细菌阳性率，并降低了医院延迟的风险。35 岁以上的人群、失业者和居民在患者就诊和医院诊断方面的延迟风险均高于年轻人、工人或移民。与被动病例发现相比，主动病例发现可使患者延迟的风险降低 5.47（4.85-6.19）倍。
深圳 TB 患者的细菌阳性率显著提高，但诊断延迟仍然严重，在风险人群中进行主动病例发现和优化分子检测时需要更加注意。
