Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal

BMC Public Health

Raquel Duarte¹  Andreia Leite²  Patrícia Soares²  Carla Nunes²  João Almeida Santos³ 

[1] Chest Disease Center, Vila Nova de Gaia, Rua Conselheiro Veloso da Cruz, 4400-092, Vila Nova de Gaia, Portugal;Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal;NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal;Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal;NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal;National Health Institute Dr. Ricardo Jorge, Avenida Padre Cruz, 1600-560, Lisbon, Portugal;Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056, Lisbon, Portugal;

关键词: Pulmonary tuberculosis;    Patient delay;    Healthcare delay;    Total delay;    Tuberculosis control;    Public health;   

DOI  :  10.1186/s12889-021-12245-y

来源: Springer

【 摘 要 】

BackgroundEarly diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis.MethodsRetrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05.ResultsMedian patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19–71), 8 days (IQR: 1–32) and 62 days (IQR: 38–102), respectively.The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis.In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay.ConclusionsPatient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study.This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.

【 授权许可】

CC BY