贵阳市2014—2020年学生肺结核患者发现就诊及确诊延迟影响因素分析

  目的  对2014—2020年贵阳市学生肺结核患者发现、就诊及确诊延迟影响因素进行分析，为贵阳市学生肺结核防控工作提供参考依据。  方法  通过《结核病管理信息系统》收集2014—2020年贵阳市学生肺结核患者病案信息，分析学生肺结核患者发现、就诊、确诊延迟的基本情况及变化趋势，采用χ2检验及多因素Logistic回归模型分析3类延迟的影响因素。  结果  2014—2020年贵阳市学生肺结核患者发现、就诊延迟率总体呈上升趋势(χ_趋势2值分别为20.70，31.03，P值均 < 0.05)。2014—2020年贵阳市共报告1 323例有效病例，发现天数中位数为16 d，发现延迟率为48.75%;就诊天数中位数是11 d，就诊延迟率为43.46%;确诊天数中位数为0 d，确诊延迟率为11.87%。多因素Logistic回归模型分析显示，流动人口与发现延迟呈正相关(OR=1.45)，患者来源分类为其他(OR=0.19)、首诊单位级别是县级(OR=0.44)、首诊单位类型为综合医院(OR=0.58)与学生肺结核发现延迟均呈负相关(P值均 < 0.05)。女生(OR=1.32)、流动人口(OR=1.38)与就诊延迟均呈正相关(P值均 < 0.01)。流动人口(OR=1.51)、非重症(OR=5.99)、近城区(OR=2.76)、远城区(OR=4.30)与发生确诊延迟均呈正相关(P值均 < 0.05)，女生(OR=0.65)、少数民族(OR=0.38)、学段为大中专(OR=0.53)、首诊单位类型为专科医院(OR=0.22)与确诊延迟发生均呈负相关(P值均 < 0.05)。  结论  贵阳市学生肺结核发现、就诊延迟的情况较为普遍。应针对性制定防控措施，降低学生延迟发生率，减少学校结核聚集性疫情的发生风险。

Determinants of the delay in case-finding,treatment, and diagnosis among students tuberculosis patients in Guiyang from 2014 to 2020

  Objective  To analyze factors affecting the delay in the case-finding, treatment and diagnosis of tuberculosis among students during 2014-2020, and to provide a reference for the prevention and control measures of tuberculosis among students in Guiyang City.  Methods  The medical cases of students with tuberculosis from 2014 to 2020 recorded by "China Disease Prevention and Control Information System" were collected and trend of delays in the detection, treatment, and diagnosis of students with tuberculosis were analyzed, and χ2 test and multivariate Logistic regression were used to analyze influencing factors.  Results  From 2014 to 2020, the rate of delay in the case-finding, treatment, and diagnosis of tuberculosis among students in Guiyang showed a relatively stable trend. From 2014 to 2020, Guiyang City reported a total of 1 323 valid cases, the median number of case-finding was 16 days, and 48.75% of student TB patients were delayed; the median number of treatment was 11 days, the delay rate of treatment was 43.46%; the median number of diagnosis was 0 day, the diagnosis delay rate was 11.87%. The  results  of multivariate Logistic regression analysis showed that the floating population was a risk factor for delay in case-finding (OR=1.45), the classification of the source of patients as "other" (OR=0.19), the level of the first diagnosed unit was county (OR=0.44), and the type of the first diagnosed unit was general hospital (OR=0.58) were the protective factors for the delayed case-finding of tuberculosis in students(P < 0.05). Female (OR=1.32) and floating population (OR=1.38) were risk factors for delayed treatment. Floating population (OR=1.51), rural areas (OR=4.30), urban fringe (OR=2.76), non-severe patients (OR=5.99) were risk factors for delayed diagnosis, females (OR=0.65), ethnic minorities (OR=0.38), college degree (OR=0.53), and the first diagnosis unit wae a specialist hospital (OR=0.22) were protective factors for delayed diagnosis of tuberculosis in students (P < 0.05).  Conclusion  The rates of tuberculosis case-finding and treatment delay among students are common, which warrants targeted prevention and control measures to reduce the incidence of student delays and reduce the risk of tuberculosis cluster epidemics in schools.