Zhou Fangjing, Sun Qi, Huang ShanShan, Li Jianwei, Chen Yuhui, Feng Huiying
Center for Tuberculosis Control of Guangdong Province, Guangzhou, 510630, China.
The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
BMC Public Health. 2025 May 20;25(1):1854. doi: 10.1186/s12889-025-23031-5.
The prevalence of delays in receiving effective tuberculosis (TB) prevention and control measures is notably high, particularly among elderly patients. This study aims to explore the trends in diagnostic delays and assess the factors associated with these delays among elderly pulmonary tuberculosis (PTB) patients in Guangdong Province, Southern China.
We analyzed surveillance data from the Tuberculosis Information Management System (TBIMS), covering pulmonary tuberculosis cases in Guangdong Province from 2010 to 2022. We categorized patient delay (PD), health system delay (HSD), and total diagnostic delay (TDD) among patients aged 60 years and older. Trends in annual delays were examined using a Joinpoint regression program. Both univariate and multivariate logistic regression analyses were conducted to identify factors influencing TDD.
The study found that the notification rate of PTB among elderly patients decreased from 155.85 per 100,000 in 2010 to 71.15 per 100,000 in 2022. However, the proportion of elderly patients among newly diagnosed TB cases increased from 20.66% to 30.37%. The median PD decreased from 29 days to 21 days, while the median HSD increased from 0 days to 3 days. Consequently, the TDD remained stable at 32 days. The average delay rates for PD, HSD, and TDD were 64.80%, 13.90%, and 75.80%, respectively. Joinpoint regression analysis showed a decreasing trend in PD rate and an increasing trend in HSD rate among patients aged ≥ 60 years, but no statistically significant change in TDD rate was observed. Significant risk factors for higher TDD included being a farmer, first visit to non-designated facilities, initial diagnosis at county-level hospitals, passive case finding, residence in underdeveloped areas, and respiratory comorbidities.
The burden and delays associated with TB diagnosis remain significant among the elderly in Southern China. Enhanced health education and proactive screening efforts are crucial for this high-risk group to mitigate diagnostic delays, particularly for those with respiratory comorbidities and in less developed regions. Future research should focus on addressing these barriers and evaluating the effectiveness of tailored interventions to improve TB control strategies for the elderly.
在接受有效的结核病预防和控制措施方面存在延误的情况非常普遍，尤其是在老年患者中。本研究旨在探讨诊断延误的趋势，并评估中国南方广东省老年肺结核（PTB）患者中与这些延误相关的因素。
我们分析了结核病信息管理系统（TBIMS）的监测数据，涵盖2010年至2022年广东省的肺结核病例。我们对60岁及以上患者的患者延误（PD）、卫生系统延误（HSD）和总诊断延误（TDD）进行了分类。使用Joinpoint回归程序检查年度延误的趋势。进行单变量和多变量逻辑回归分析以确定影响TDD的因素。
研究发现，老年患者中PTB的报告率从2010年的每10万人155.85例降至2022年的每10万人71.15例。然而，新诊断的结核病病例中老年患者的比例从20.66%增加到30.37%。中位PD从29天降至21天，而中位HSD从0天增加到3天。因此，TDD保持在32天稳定。PD、HSD和TDD的平均延误率分别为64.80%、13.90%和75.80%。Joinpoint回归分析显示，60岁及以上患者的PD率呈下降趋势，HSD率呈上升趋势，但TDD率未观察到统计学上的显著变化。TDD较高的显著风险因素包括是农民、首次就诊于非指定机构、在县级医院初次诊断、被动发现病例、居住在欠发达地区以及患有呼吸系统合并症。
在中国南方，老年人中与结核病诊断相关的负担和延误仍然很大。加强健康教育和积极的筛查工作对于这个高危群体减轻诊断延误至关重要，特别是对于那些患有呼吸系统合并症和生活在欠发达地区的人。未来的研究应侧重于解决这些障碍，并评估针对性干预措施的有效性，以改善老年人的结核病控制策略。
