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中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (5): 510-517.doi: 10.3969/j.issn.1000-6621.2020.05.017

• 论著 • 上一篇    下一篇

2008—2018年广州市结核病患者就诊延迟影响因素分析

沈鸿程, 杜雨华, 张广川, 吴桂锋, 刘健雄, 李铁钢()   

  1. 510095 广州市胸科医院(沈鸿程、杜雨华、吴桂锋、刘健雄、李铁钢);广东药科大学公共卫生学院(张广川)
  • 收稿日期:2020-02-14 出版日期:2020-05-10 发布日期:2020-05-08
  • 通信作者: 李铁钢 E-mail:tiegang1977@126.com
  • 基金资助:
    “十三五”国家科技重大专项(2018ZX10715004-002-017);广州市高水平临床重点专科和培育专科建设项目(穗卫函[2019]1555号);广东省转化医学创新平台培育建设项目B类(粤卫函[2018]1254号);广州市卫生健康科技重大项目(2020A031003)

Influencing factors of pulmonary tuberculosis patient delay in Guangzhou, 2008—2018

SHEN Hong-cheng, DU Yu-hua, ZHANG Guang-chuan, WU Gui-feng, LIU Jian-xiong, LI Tie-gang()   

  1. Guangzhou Chest Hospital, Guangzhou 510095, China
  • Received:2020-02-14 Online:2020-05-10 Published:2020-05-08
  • Contact: LI Tie-gang E-mail:tiegang1977@126.com

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摘要：

目的 分析2008—2018年广州市结核病患者就诊延迟变化趋势及影响因素,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125201例结核病患者的信息,包括户籍、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就诊延迟的影响因素。 结果 2008—2018年广州市结核病患者从出现症状至就诊的天数中位数(四分位数)为13(2,38)d,就诊延迟率为49.25%(61656/125201)。单因素分析结果显示,女性、年龄≥65岁、少数民族、职业为儿童、患者来源为追踪、患者分类为肺外结核、存在并发症者的就诊延迟率分别为49.98%(19951/39919)、53.60%(8323/15528)、52.05%(1128/2167)、64.66%(161/249)、53.06%(5347/10078)、56.27%(3465/6158)、63.80%(1202/1884),明显高于男性(48.90%,41705/85282)、年龄<25岁(43.99%,11493/26129)、汉族(49.20%,60528/123034)、教师/医务人员/干部(46.49%,1848/3975)、患者来源为健康检查(23.94%,643/2686)、患者分类为肺结核(48.88%,58191/119043)、无并发症者(49.02%,60454/123317),差异均有统计学意义(χ2值分别为12.60、664.34、6.96、878.51、940.21、127.79、162.12,P值分别为<0.001、<0.001、0.008、<0.001、<0.001、<0.001、<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就诊延迟:女性[以男性为参照,OR(95%CI)=1.11(1.08~1.13)],年龄组为25~、45~、≥65岁[以<25岁年龄组为参照,OR(95%CI)值分别为1.13(1.09~1.16)、1.37(1.32~1.42)、1.40(1.33~1.47)],少数民族[以汉族为参照,OR(95%CI)=1.22(1.12~1.33)];职业为儿童、工人/民工、农民、其他[以教师/医务人员/干部为参照,OR(95%CI)值分别为2.38(1.80~3.15)、1.17(1.10~1.26)、1.38(1.28~1.48)、1.17(1.10~1.25)],患者来源为因症就诊、因症推荐、转诊、追踪[以健康检查来源为参照,OR(95%CI)值分别为3.06(2.79~3.35)、3.27(2.83~3.77)、2.78(2.54~3.05)、3.35(3.04~3.70)],肺外结核[以肺结核为参照,OR(95%CI)=1.41(1.33~1.49)],有并发症[以无并发症为参照,OR(95%CI)=1.62(1.47~1.78)]。 结论 2008—2018年广州市结核病患者就诊延迟现象较为普遍,对上述各类就诊延迟的高危因素,需要重点加强关注。

关键词: 结核, 就诊延迟, 因素分析,统计学

Abstract:

Objective To analyze the trend and influencing factors of pulmonary tuberculosis (PTB) patient delay in Guangzhou from 2008 to 2018, and to provide scientific evidence for the development of prevention and control measures. Methods Data of 125201 PTB cases registered and treated in Guangzhou from 2008 to 2018 were collected from TB Management Information System of China Information System for Disease Control and Prevention, including residence, gender, age, ethnicity, occupation, cases source, cases classification and complication. Influencing factors of PTB patient delay were analyzed by univariate and multivariate logistic regression. Results Median of days (quartiles) from symptom onset to seeking health care was 13 (2, 38) days in Guangzhou from 2008 to 20l8, with 49.25% (61656/125201) of PTB patients delayed in seeking health care. Univariate analysis showed that patient delay rates of female, aged ≥65, ethnic minorities, children, cases from tracing, extrapulmonary tuberculosis, with complications were significantly higher than those of male (49.98% (19951/39919) vs 48.90% (41705/85282)) (χ 2=12.60, P<0.001), aged <25 (53.60% (8323/15528) vs 43.99% (11493/26129)) (χ 2=664.34, P<0.001), ethnic HAN (52.05% (1128/2167) vs 49.20% (60528/123034)) (χ 2=6.96, P=0.008), teacher or doctor or cadre (64.66% (161/249) vs 46.49% (1848/3975)) (χ 2=878.51, P<0.001), health check (53.06% (5347/10078) vs 23.94% (643/2686)) (χ 2=940.21, P<0.001), PTB (56.27% (3465/6158) vs 48.88% (58191/119043)) (χ 2=127.79, P<0.001) and without complications (63.80% (1202/1884) vs 49.02% (60454/123317)) (χ 2=162.12, P<0.001), respectively. Multivariate logistic regression analysis showed those with the following characteristics were more likely to delay in seeking health care: female (male as reference, OR (95%CI)=1.11 (1.08-1.13)), aged 25-, 45-, ≥65 (aged <25 as reference, OR (95%CI)=1.13 (1.09-1.16), 1.37 (1.32-1.42) and 1.40 (1.33-1.47), respectively), ethnic minorities (ethnic HAN as reference, OR (95%CI)=1.22 (1.12-1.33)), children, worker/civilian worker, farmer, others (teacher or doctor or cadre as reference, OR (95%CI)=2.38 (1.80-3.15), 1.17 (1.10-1.26), 1.38 (1.28-1.48) and 1.17 (1.10-1.25), respectively), clinical consultation, recommendation, referral, tracing (health check as reference, OR (95%CI)=3.06 (2.79-3.35), 3.27 (2.83-3.77), 2.78 (2.54-3.05) and 3.35 (3.04-3.70), respectively), extrapulmonary tuberculosis (pulmonary tuberculosis as reference, OR (95%CI)=1.41 (1.33-1.49)), with complications (without complications as reference, OR (95%CI)=1.62(1.47-1.78)). Conclusion Patient delay is rather common in pulmonary tuberculosis patients in Guangzhou from 2008 to 2018. The influencing factors mentioned above for patient delay should be paid more attention.

Key words: Tuberculosis, Patient delay, Factor analysis,statistical

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