山东户籍及流动人口肺结核患者就诊延迟现状及影响因素

目的了解户籍与流动人口肺结核患者的就诊延迟现状及其影响因素。方法采用单纯随机抽样方法选取山东省4个全球基金项目县，通过自制问卷对目标县登记的肺结核患者进行调查。结果调查的928例患者中户籍人口患者595例（64.1%），流动人口患者333例（35.9%），中位年龄分别为51和28岁，就诊间隔的中位天数分别为30和17 d，就诊延迟率分别为66.4%和56.2%；多因素logistic回归分析结果显示，咳嗽咳痰（OR=3.0，95%CI=1.6~5.6）、痰检阳性（OR=1.7，95%CI=1.0~2.9）、就诊患者（OR=7.6，95%CI=2.7~21.0）和转诊患者（OR=9.0，95%CI=3.1~26.2）是户籍人口患者就诊延迟的危险因素，咯血（OR=0.4，95%CI=0.2~0.9）是其保护因素；咳嗽咳痰（OR=2.3，95%CI=1.4~3.7）、痰检阳性（OR=1.9，95%CI=1.3~2.8）、就诊患者（OR=3.8，95%CI=1.8~8.0）和转诊患者（OR=5.6，95%CI=2.5~12.3）是流动人口患者就诊延迟的危险因素。结论无论户籍还是流动人口，对肺结核疑似症状的警惕性不强，缺乏及时到医疗卫生机构就诊的意识是其就诊延迟的主要原因，需采取针对性措施予以改进。

Patient delay and relevant factors of tuberculosis diagnosis among floating and local population

ObjectiveTo analyze the distribution and risk factors of patient delay of tuberculosis diagnosis among floating and local residents.1MethodsUse simple random sampling method,4 from 23 global fund program counties were selected.All 928 pulmonary tuberculosis(TB)cases in the 4 counties were surveyed with a self-administered questionnaire.ResultsAmong all cases,595 was local patients(54.1%)and 333 was floating patients(35.9%),with the median age of 51 and 28 years.The median duration between the onset of symptom and seeing a doctor in the local and floating patients were 30 and 17 days,with the proportion of patient delay of 66.4% and 56.2%.The results of multivariate logistic regression model displayed that cough or phlegm,sputum-smear positive,visiting a doctor,counter and transferring consultation were the risk factors of patient delay among local patients,with the odds ratio(OR)value and 95%confidence interval(95%CI)of 3.0 (1.6-5.6),1.7 (1.0-2.9),7.6 (2.7-21.0),and 9.0 (3.1-26.2)and hemoptysis was a protect factor(OR=0.4,95%CI:0.2-0.9).Cough or phlegm,sputum smear positive,visiting a doctor,and transferring consultation were the risk factors among floating patients,with the OR and 95%CI of 2.3 (1.4-3.7),1.9 (1.3-2.8),3.8 (1.8-8.0),and 5.6 (2.5-12.3),respectively.ConclusionThe major cause of the patient delay is lack of vigilant attention to TB symptom both in floating and the local patients and relevant measures need to be taken to improve the situation of patient delay.