2008—2018年广州市结核病患者诊断延误影响因素分析

目的 分析2008—2018年广州市结核病患者诊断延误趋势及影响因素,为制定防治措施提供依据。 方法 通过《中国疾病预防控制信息系统》的子系统《结核病管理信息系统》,收集2008—2018年广州市登记治疗的125180例结核病患者的信息,包括性别、年龄、民族、职业、患者来源、患者分类及并发症发生情况,采用单因素和多因素logistic回归模型分析结核病患者诊断延误的影响因素。 结果 2008—2018年广州市结核病患者从初次就诊至诊断的天数的中位数(四分位数)为5(2,15)d,诊断延误率为27.43%(34343/125180)。单因素分析结果显示,65~102岁年龄组、汉族、职业为教师/医务人员/干部、患者来源为健康检查的诊断延误率分别为29.70%(4610/15524)、27.50%(33829/123013)、33.22%(1320/3974)、37.86%(1017/2686),明显高于年龄25~<45岁(26.69%,13585/50894)、少数民族(23.72%,514/2167)、工人及民工(21.10%,4752/22520)、患者来源为转诊(25.36%,14416/56835),差异均有统计学意义(χ²值分别为65.253、15.291、879.541、570.472,P值均<0.001)。多因素logistic回归分析结果显示,以下特征的结核病患者更容易出现诊断延误: 25~<45、45~<65、65~102岁年龄组[以<25岁年龄组为参照,OR(95%CI)值分别为1.072(1.033~1.110)、1.136(1.090~1.184)、1.168(1.105~1.235)];汉族[以少数民族为参照,OR(95%CI)=1.155(1.044~1.278)];职业为儿童及学生、商业服务、教师/医务人员/干部、农民、离退休人员、家政/家务/待业、其他[以工人及民工为参照,OR(95%CI)值分别为1.730(1.617~1.851)、1.784(1.683~1.890)、1.828(1.698~1.968)、1.167(1.111~1.227)、1.632(1.535~1.736)、1.436(1.378~1.497)、1.525(1.462~1.590)];患者来源为健康检查、接触者检查、因症就诊、因症推荐、追踪 [以转诊为参照,OR(95%CI)值分别为1.704(1.572~1.848)、1.531(1.227~1.910)、1.031(1.003~1.060)、1.346(1.192~1.520)、1.535(1.467~1.606)]。结论 2008—2018年广州市结核病患者诊断延误现象逐年上升。对上述各类诊断延误的影响因素,需要重点加强关注。

Influencing factors of pulmonary tuberculosis diagnosis delay in Guangzhou,2008-2018

Objective To analyze the trend and influencing factors of pulmonary tuberculosis diagnosis delay in Guangzhou from 2008 to 2018, and to provide scientific evidence for the development of prevention and control policy and measures. Methods Information of 125180 pulmonary tuberculosis cases in Guangzhou from 2008 to 2018 was collected from Tuberculosis Information Management System of China Information System for Disease Control and Prevention, including gender, age, ethnicity, occupation, cases source, cases classification and complication. Influencing factors of pulmonary tuberculosis diagnosis delay were analyzed by univariate and multivariate logistic regression. Results The median of pulmonary tuberculosis patient from seeking medical service to diagnosis was 5 (2, 15) days in Guangzhou from 2008 to 2018, and the rate of the diagnosis delay was 27.43% (34343/125180). Univariate analysis showed that diagnosis delay rates of aged 65-102 (29.70% (4610/15524)), ethnic HAN (27.50% (33829/123013)), occupation as teacher or doctor (33.22% (1320/3974)), health examination (37.86% (1017/2686)) were significantly higher than those aged 25-<45 (26.69% (13585/50894); χ ²=65.253, P<0.001), ethnic minorities (23.72% (514/2167); χ ²=15.291, P<0.001), worker/civilian worker (21.10% (4752/22520); χ ²=879.541, P<0.001), referrals (25.36% (14416/56835); χ ²=570.472, P<0.001), respectively. Multivariate logistic regression analysis showed those with the following characteristics were more likely to be diagnosis delayed: aged 25-<45, 45-<65, 65-102 (aged <25 as reference, OR (95%CI) values were 1.072 (1.033-1.110), 1.136 (1.090-1.184), 1.168 (1.105-1.235), respectively), ethnic HAN (minorities as reference, OR (95%CI)=1.155(1.044-1.278)), children/student, business services, teachers or doctors, farmers, resigned or retired, housekeeping or unemployment, others (worker/civilian worker as reference, OR (95%CI) values were 1.730 (1.617-1.851), 1.784 (1.683-1.890), 1.828 (1.698-1.968), 1.167 (1.111-1.227), 1.632 (1.535-1.736), 1.436 (1.378-1.497), 1.525 (1.462-1.590), respectively), health examination, contact screening, clinical consultation, recommendation, tracing (referrals as reference, OR (95%CI) values were 1.704 (1.572-1.848), 1.531 (1.227-1.910), 1.031 (1.003-1.060), 1.346 (1.192-1.520), 1.535(1.467-1.606), respectively). Conclusion Diagnosis delay of pulmonary tuberculosis cases appears to be increased year by year in Guangzhou from 2008 to 2018. It is necessary to pay more attention to the factors affecting the above diagnosis delay.