2010—2019年福建省结核病患者就诊延迟及影响因素分析

doi:10.19982/j.issn.1000-6621.20220294

摘要/Abstract

摘要：

目的: 分析2010—2019年福建省结核病患者就诊延迟特征及其影响因素,为制定和调整结核病防治措施提供依据。方法: 收集2010—2019年福建省登记治疗的174124例结核病患者相关数据,描述其就诊延迟时间和就诊延迟率分布情况和变化趋势,采用logistic回归模型分析其影响因素。结果: 2010—2019年福建省结核病患者就诊延迟时间中位数(四分位数)为21(6,58)d,平均就诊延迟率为59.12%(102940/174124)。多因素分析显示,女性(OR=1.058,95%CI:1.035~1.082)、年龄25~64岁(OR=1.272,95%CI:1.232~1.313)和≥65岁(OR=1.427,95%CI:1.372~1.483)、职业为体力劳动(OR=1.195,95%CI:1.119~1.276)和退休/待业(OR=1.112,95%CI:1.039~1.190)、现住址为福建省其他地级市(OR=1.681,95%CI:1.550~1.822)、患者来源为接触者检查(OR=1.704,95%CI:1.216~2.387)和被动发现(OR=3.715,95%CI:3.340~4.131)、诊断分型为结核性胸膜炎(OR=1.454,95%CI:1.354~1.562)和肺外结核(OR=1.935,95%CI:1.645~2.276)、防治服务体系转型后(OR=1.103,95%CI:1.078~1.130)、现住址与首诊单位距离≥30km(OR=1.077,95%CI:1.048~1.107)等均为就诊延迟发生的危险因素。病原学阴性或未查(OR=0.650,95%CI:0.637~0.663)和职业为学生及儿童(OR=0.864,95%CI:0.792~0.943)均为就诊延迟的保护因素。结论: 福建省结核病就诊延迟率仍处于较高水平,应进一步提高医疗服务水平和改善就医可及性,针对重点人群加强宣传教育并积极开展主动筛查,降低患者就诊延迟率。

关键词: 结核, 就诊延误, 因素分析, 流行病学研究, 福建省

Abstract:

Objective: To analyze the trend and related factors of patients delay among tuberculosis patients in Fujian Province from 2010 to 2019, and to provide basis for the formulation and adjustment of tuberculosis control measures. Methods: The data of 174124 tuberculosis patients registered and treated in Fujian Province from 2010 to 2019 were collected to describe the distribution and trend of patient delay. The factors associated with patient delay were analyzed by multivariate logistic regression model. Results: The median number of days from symptom onset to seeking health care was 21 (6, 58) days in Fujian Province from 2010 to 2019, with an average patient delay rate of 59.12% (102940/174124). Multivariate logistic regression analysis showed that female (OR=1.058, 95%CI: 1.035-1.082), aged 25-64 (OR=1.272, 95%CI: 1.232-1.313) and ≥65 (OR=1.427, 95%CI: 1.372-1.483), manual labor (OR=1.195, 95%CI: 1.119-1.276) and retirement or unemployed (OR=1.112, 95%CI: 1.039-1.190), current residency address in other cities of Fujian Province (OR=1.681, 95%CI: 1.550-1.822), contact inspection (OR=1.704, 95%CI: 1.216-2.387) and passive case-finding (OR=3.715, 95%CI: 3.340-4.131), tuberculous pleurisy (OR=1.454, 95%CI: 1.354-1.562)and extrapulmonary tuberculosis (OR=1.935,95%CI: 1.645-2.276), designated hospital model (OR=1.103, 95%CI: 1.078-1.130) and the distance between the current residency address and hospital ≥30 km (OR=1.077, 95%CI: 1.048-1.107) were high risk factors for patient delay. Students or children (OR=0.864, 95%CI: 0.792-0.943) and negative etiological examination (OR=0.650, 95%CI: 0.637-0.663) were low risk factors for patient delay. Conclusion: The patient delay rate in Fujian Province is still at a high level. We should improve the quality and accessibility of medical services, strengthen health education for key populations, and actively carry out active screening to reduce the patient delay.

Key words: Tuberculosis, Patient delay, Factor analysis, statistical, Epidemiologic studies, Fujian Province

中图分类号:

陈代权, 林淑芳, 周银发, 陈堃, 戴志松. 2010—2019年福建省结核病患者就诊延迟及影响因素分析[J]. 中国防痨杂志, 2023, 45(1): 96-103. doi: 10.19982/j.issn.1000-6621.20220294

Chen Daiquan, Lin Shufang, Zhou Yinfa, Chen Kun, Dai Zhisong. Patient delay and related factors among tuberculosis patient in Fujian Province, 2010—2019[J]. Chinese Journal of Antituberculosis, 2023, 45(1): 96-103. doi: 10.19982/j.issn.1000-6621.20220294

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参考文献 17

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变量	赋值
性别	男性=1,女性=2
年龄	<25岁=1,25~64岁=2,≥65岁=3
民族	汉族=1,少数民族=2
职业	企事业职工=1,学生及儿童=2,公共场所及商业服务=3,体力劳动=4,退休及待业=5,职业不详=6
患者所属地市	厦门市=1,福州市和平潭综合实验区=2,莆田市=3,三明市=4,泉州市=5,漳州市=6,南平市=7,龙岩市=8,宁德市=9
现住址	本县(区)=1,本市其他县(区)=2,本省其他地级市=3
患者来源	健康检查=1,接触者筛查=2,被动发现=3
诊断分类	肺结核=1,结核性胸膜炎=2,肺外结核=3
病原学结果	病原学阳性=1,病原学阴性/未查=2
结核病防治服务模式	转型前=1,转型后=2
现住址与首诊单位距离	<10km=1, 10~29km=2, ≥30km=3