关键词: 结核,肺, 学生, 就诊延误, 因素分析,统计学, 流行病学研究, 湖南省

Abstract:

Objective: To analyze the current situation and influencing factors of the detection delay among student with pulmonary tuberculosis in Hunan from 2011 to 2020, and to provide reference for decision of school tuberculosis prevention and control. Methods: The medical records of 17365 student with pulmonary tuberculosis in Hunan from January 1, 2011 to December 31, 2020 were collected from the “Tuberculosis Management Information System”, a subsystem of the “China Disease Prevention and Control Information System”, including gender, age, patient of origin, diagnosis results, level of diagnosis unit, severe condition, treatment classification, time of registration, date of occurrence of symptoms, first diagnosis and diagnosis, etc. Univariate analysis was used to compare the differences between groups of different factors, and multivariate logistic regression analysis was used to analyze the influencing factors of the detection delay among student with pulmonary tuberculosis. Results: From 2011 to 2020, the median (quartile) time of visit, diagnosis and detection of pulmonary tuberculosis patients among students were 12 (3, 33) d, 2 (0, 18) d and 27 (11, 53) d, respectively; the rate of rist, diagnosis and the delay of detection were 45.8% (7955/17365), 28.6% (4965/17365) and 48.6% (8438/17365); and the delay rate of detection decreased from 49.1% (774/1575) in 2011 to 43.6% (1064/2438) in 2020, showing a slow downward trend ( {\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^2=25.203, P=0.000), and there were regional differences (34.4% (303/881)-63.9% (1664/2606); {\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^2=451.797, P=0.000). Among 8438 patients with detection delay, the delay rate of visit (71.6% (6042/8438)) was significantly higher than that of diagnosis (48.0% (4048/8438))(χ²=979.975, P=0.000), and 64.2% (5267/8438) of the patients with detection delay were found that the visit days was 28 days or more. Multivariate logistic regression analysis showed that the risk of detection delay was relatively low in those who younger than 15 years old, aged at 15-19 years or 20-24 years, physical examination, or contact inspection (OR (95%CI): 0.679 (0.495-0.932), 0.576 (0.424-0.782), 0.707 (0.519-0.964), 0.213 (0.138-0.328) and 0.214 (0.118-0.388), respectively), but the risk of detection delay of the follow up and severely patients were relatively high (OR (95%CI): 2.061 (1.405-3.022) and 1.475 (1.244-1.750), respectively). Conclusion: From 2011 to 2020,the detection delay among student with pulmonary tuberculosis in Hunan was relatively high, but showed a slow downward trend, the delay was mainly visit delay, and there were regional differences. Attention should be paid to patients who was upperclassman, did not receive physical examination and contact inspection, and who found by follow-up, so as to achieve early detection and diagnosis and avoid the occurrence of severe tuberculosis.

Key words: Tuberculosis, pulmonary, Student, Patient delay, Factor analysis, statistical, Epidemiologic studies, Hunan Province