2009 - 2015年盐城市肺结核患者就诊延迟影响因素分析

目的 分析盐城市肺结核患者就诊延迟的影响因素，为早发现并控制肺结核提供科学依据。方法 收集“结核病管理信息系统”中盐城市2009 - 2015年确诊的24 656例肺结核患者病案信息，描述并分析就诊延迟的影响因素。结果 盐城市肺结核患者就诊延迟时间中位数30 d，就诊延迟率58.5%。与男性、青年、因症就诊/推荐、非重症、北五县患者相比，女性（OR = 1.10，95%CI: 1.04～1.17）、老年（OR = 1.46，95%CI: 1.35～1.58）、追踪（OR = 1.69，95%CI: 1.51～1.89）、重症（OR =1.25，95%CI: 1.13～1.38）、中（OR = 2.06，95%CI: 1.92～2.22）南（OR = 1.65，95%CI: 1.54～1.76）四区（市）患者就诊延迟风险更高。非农民（OR = 0.91，95%CI: 0.85～0.99）、痰检涂阴（OR = 0.86，95%CI: 0.81～0.91）、新型服务体系实施后（OR = 0.80，95%CI: 0.75～0.85）的患者就诊延迟风险分别低于农民、痰检涂阳和新型服务体系实施前的患者。结论 盐城市肺结核患者就诊延迟现象较严重，年龄、是否农民、重症、性别、痰检结果、区域、新型服务体系是其影响因素，应采取综合措施减少就诊延迟。

Analysis of patient delay and the influencing factors of pulmonary tuberculosis in Yancheng City during 2009-2015

Objective To study patient delay and the influencing factors of pulmonary tuberculosis（PTB）, so as to provide scientific evidence for early detection and control of PTB. Methods We collected information of 24656 cases with PTB from tuberculosis management information system during 2009-2015, described and analyzed the influencing factors of patient delay. Results The median time of PTB patients delay in Yancheng was 30 d, while the rate was 58.5%. Compared with the male, youth, clinic visit or recommend due to symptoms, non-severe, and northern five counties, the patient delay risks of the female（OR =1.102，95%CI: 1.040-1.167），old（OR =1.461，95%CI: 1.350-1.582）, trace（OR =1.693，95%CI: 1.514-1.893），severe（OR =1.248，95%CI: 1.128-1.382）, four districts and cities of middle（OR =2.062，95%CI: 1.920-2.215）and south（OR =1.651，95%CI: 1.544-1.764）were higher. Compared with the farmers, sputum smear positive and before implementation the new service system, the patient delay risks of the non-farmers（OR =0.913，95%CI: 0.846-0.985）, sputum smear negative（OR =0.861，95%CI: 0.813-0.912）, and after implementing the new service system（OR =0.800，95%CI: 0.752-0.850）were lower. Conclusion The PTB patients delay in Yancheng was serious. Age, whether or not being farmers and severity, sex, sputum examination results, regional and new service system were the influencing factors. The comprehensive measures should be taken to reduce patient delay.