Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
Department of Tuberculosis Control and Prevention, Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China.
Front Public Health. 2023 Aug 11;11:1233637. doi: 10.3389/fpubh.2023.1233637. eCollection 2023.
Tuberculosis (TB) remains a major public health challenge. However, indicators of delays in assessing effective TB prevention and control and its influencing factors have not been investigated in the eastern coastal county of China.
All notified pulmonary tuberculosis (PTB) cases in the Fenghua District, China were collected between 2010 and 2021 from the available TB information management system. Comparison of delays involving patient, health system, and total delays among local and migrant cases. Additionally, in correlation with available Basic Public Health Service Project system, we performed univariate and multivariate logistic regression analyses identified the influencing factors associated with patient and total delays in patients aged >60 years.
In total, 3,442 PTB cases were notified, including 1,725 local and 1,717 migrant patients, with a male-to-female ratio of 2.13:1. Median patient and total delays of local TB patients were longer than those for migrant patients; the median health system delay did not show any significant difference. For patient delay among the older adult, female (cOR: 1.93, 95% CI: 1.07-3.48), educational level of elementary school and middle school (cOR: 0.23, 95% CI: 0.06-0.84) had a statistical difference from univariable analysis; however, patients without diabetes showed a higher delay for multiple-factor analysis (aOR: 2.12, 95% CI: 1.02-4.41). Furthermore, only the education level of elementary school and middle school presented a low total delay for both univariate (cOR: 0.22, 95% CI: 0.06-0.82) and multivariate analysis (aOR: 0.21, 95% CI: 0.05-0.83) in the older patients.
The delay of TB cases among migrants was lower than the local population in the Fenghua District, which may be related to the "healthy migrant effect". It highlights that women, illiterate people, and people without diabetes are key groups for reducing delays among older adults. Health awareness should focus on these target populations, providing accessible health services, and reducing the time from symptom onset to diagnosis.
结核病（TB）仍然是一个主要的公共卫生挑战。然而，在中国东部沿海县，尚未研究评估有效结核病预防和控制的延迟指标及其影响因素。
从现有的结核病信息管理系统中收集了 2010 年至 2021 年期间中国奉化市所有报告的肺结核（PTB）病例。比较本地和移民病例之间的患者、卫生系统和总延迟差异。此外，结合现有的基本公共卫生服务项目系统，我们进行了单变量和多变量逻辑回归分析，确定了与年龄>60 岁的患者的患者和总延迟相关的影响因素。
共报告了 3442 例 PTB 病例，包括 1725 例本地和 1717 例移民患者，男女比例为 2.13:1。本地结核病患者的中位患者和总延迟均长于移民患者；中位卫生系统延迟无显著差异。对于老年患者的患者延迟，女性（cOR：1.93，95%CI：1.07-3.48），小学和中学教育程度（cOR：0.23，95%CI：0.06-0.84）与单变量分析有统计学差异；然而，无糖尿病的患者在多因素分析中表现出更高的延迟（aOR：2.12，95%CI：1.02-4.41）。此外，仅小学和中学的教育程度在单变量（cOR：0.22，95%CI：0.06-0.82）和多变量分析（aOR：0.21，95%CI：0.05-0.83）中均表现出老年患者的总延迟较低。
奉化市移民结核病病例的延迟低于本地人口，这可能与“健康移民效应”有关。这突出表明，女性、文盲和无糖尿病患者是减少老年人群延迟的关键人群。卫生意识应针对这些目标人群，提供可及的卫生服务，并缩短从症状出现到诊断的时间。
