Analysis on the trend and influencing factors of detection delay in patients with active tuberculosis in Guangdong Province from 2016 to 2020

doi:10.19982/j.issn.1000-6621.20220389

Abstract

Abstract:

Objective: To analyze the trend of detection delay among patients with active pulmonary tuberculosis (APTB) in Guangdong Province during the 13^rd five-year plan period and explore the influencing factors, so as to provide scientific basis for reducing the detection delay. Methods: Based on the Tuberculosis management information system, a retrospective cohort study was conducted to collected medical records of APTB patients registered in Guangdong Province from 2016 to 2020, demographic characteristics and latency trends of 277684 patients who were finally included in the analysis were described. Cox proportional hazard model was used to analyze influencing factors of detection delay. Results: The detection delay was found in 146345 APTB patients in Guangdong Province, with the average annual delay rate of 52.70% (146345/277684) from 2016 to 2020. And the median and quartile of detection delay were 30 (14, 63) days. From 2016 to 2020, the annual detection delay rates were 50.66% (30693/60591), 50.86% (30436/59841), 53.44% (30061/56253), 55.53% (29418/52980), and 53.60% (25737/48019), respectively, which increased with time ( $χ t r e n d 2$ =380.599, P<0.001). The median of detection delayed days increased from 29 days in 2016 to 31 days in 2020. Cox proportional hazard model showed that male (HR=1.042, 95%CI: 1.033-1.051), other occupation (HR=1.077, 95%CI: 1.067-1.087), detention personnel (HR=1.108, 95%CI: 1.068-1.149), diagnosed in provincial or municipal medical institutions (HR=1.106, 95%CI: 1.094-1.118), diagnosed by CDC/TB Prevention and Control Institute and other professional institutions (HR=1.197, 95%CI: 1.184-1.210) and re-treatment (HR=1.146, 95%CI: 1.127-1.164) were the protective factors of detection delay of APTB. Migrants (HR=0.986, 95%CI: 0.978-0.995), patients found passively (HR=0.970, 95%CI: 0.962-0.978) and severe tuberculosis (HR=0.931, 95%CI: 0.919-0.942) were the risk factors of tuberculosis detection delay. Conclusion: The incidence of detection delay in APTB in Guangdong Province increased with time from 2016 to 2020. More attention should be paid to the migrants, patients found passively and severe tuberculosis patients.

Key words: Tuberculosis, pulmonary, Factor analysis, statistics, Guangdong Province

CLC Number:

R52
C811

Zhou Fangjing, Feng Huiying, Fang Lanjun, Chen Yuhui, Wen Wenpei, Liao Qinghua, Wu Huizhong. Analysis on the trend and influencing factors of detection delay in patients with active tuberculosis in Guangdong Province from 2016 to 2020[J]. Chinese Journal of Antituberculosis, 2023, 45(1): 85-95. doi: 10.19982/j.issn.1000-6621.20220389

Figures/Tables 5

特征		合计 (277684例)		发现延迟				χ²值	P值
特征		合计 (277684例)		否(131339例)		是(146345例)		χ²值	P值
性别								2.537	0.111
男性		199644(71.90)		94616(47.39)		105028(52.61)
女性		78040(28.10)		36723(47.06)		41317(52.94)
年龄组(岁)								1878.623	<0.001
0~4		146(0.05)		65(44.52)		81(55.48)
5~14		1116(0.40)		581(52.06)		535(47.94)
15~24		41133(14.81)		22039(53.58)		19094(46.42)
25~34		52860(19.04)		26871(50.83)		25989(49.17)
35~44		38173(13.75)		18782(49.20)		19391(50.80)
45~54		50262(18.10)		22983(45.73)		27279(54.27)
55~64		45502(16.39)		19547(42.96)		25955(57.04)
≥65		48492(17.46)		20471(42.22)		28021(57.78)
民族								17.806	<0.001
汉族		271378(97.73)		128191(47.24)		143187(52.76)
其他民族		6306(2.27)		3148(49.92)		3158(50.08)
职业								656.981	<0.001
农民/工人等		213581(76.92)		98178(45.97)		115403(54.03)
其他		64103(23.08)		33161(51.73)		30942(48.27)
流动人口								393.597	<0.001
否		154159(55.52)		75508(48.98)		78651(51.02)
是		123525(44.48)		55831(45.20)		67694(54.80)
羁押人员								90.358	<0.001
否		274584(98.88)		129610(47.20)		144974(52.80)
是		3100(1.12)		1729(55.77)		1371(44.23)
患者来源								31.613	<0.001
主动发现		94461(34.02)		45379(48.04)		49082(51.96)
被动发现		183223(65.98)		85960(46.92)		97263(53.08)
诊断单位级别								90.738	<0.001
省市级机构		94315(33.96)		45796(48.56)		48519(51.44)
市级以下基层机构		183369(66.04)		85543(46.65)		97826(53.35)
特征	合计 (277684例)		发现延迟				χ²值		P值
特征	合计 (277684例)		否(131339例)		是(146345例)		χ²值		P值
诊断单位类型							754.432		<0.001
疾控中心/结防所等专业机构	187304(67.45)		91977(49.11)		95327(50.89)
其他非定点医疗机构	90380(32.55)		39362(43.55)		51018(56.45)
诊断结果							1374.044		<0.001
病原学阳性	118438(42.65)		51258(43.28)		67180(56.72)
病原学阴性	151102(54.42)		76055(50.33)		75047(49.67)
单纯结核性胸膜炎	5519(1.99)		2849(51.62)		2670(48.38)
其他肺外结核	2625(0.94)		1177(44.84)		1448(55.16)
重症							36.346		<0.001
否	249703(89.92)		118582(47.49)		131121(52.51)
是	27981(10.08)		12757(45.59)		15224(54.41)
耐多药结核病							39.120		<0.001
否	269464(97.04)		127730(47.40)		141734(52.60)
是	8220(2.96)		3609(43.91)		4611(56.09)
治疗分类							111.296		<0.001
初治	261162(94.05)		124181(47.55)		136981(52.45)
复治	16522(5.95)		7158(43.32)		9364(56.68)

变量		β值		s $x ˉ$ 值		χ²值	P值	aHR(95%CI)值
年份							<0.001	-
2016(参照组)								1.000
2017		-0.012		0.006		4.640	0.031	0.988(0.977~0.999)
2018		-0.055		0.006		87.332	<0.001	0.946(0.935~0.957)
2019		-0.074		0.006		151.237	<0.001	0.929(0.918~0.940)
2020		-0.044		0.006		49.993	<0.001	0.957(0.945~0.969)
性别
男性		0.041		0.004		91.041	<0.001	1.042(1.033~1.051)
女性(参照组)								1.000
年龄组(岁)							<0.001	-
0~4(参照组)								1.000
5~14		0.170		0.088		3.721	0.054	1.185(0.997~1.409)
15~24		0.196		0.083		5.549	0.018	1.216(1.033~1.431)
25~34		0.139		0.083		2.821	0.093	1.150(0.977~1.353)
35~44		0.090		0.083		1.184	0.277	1.095(0.930~1.288)
45~54		0.024		0.083		0.080	0.777	1.024(0.870~1.250)
55~64		-0.019		0.083		0.054	0.816	0.981(0.833~1.154)
≥65		-0.054		0.083		0.422	0.516	0.947(0.805~1.115)
变量	β值		s $x ˉ$ 值		χ²值		P值	aHR(95%CI)值
职业
农民/工人等(参照组)								1.000
其他	0.074		0.005		244.293		<0.001	1.077(1.067~1.087)
流动人口
否(参照组)								1.000
是	-0.014		0.004		10.446		0.001	0.986(0.978~0.995)
羁押人员
否(参照组)								1.000
是	0.102		0.018		30.706		<0.001	1.108(1.068~1.149)
患者来源
主动发现(参照组)								1.000
被动发现	-0.030		0.004		54.899		<0.001	0.970(0.962~0.978)
诊断单位级别
市级以下基层机构(参照组)								1.000
省市级机构	0.101		0.005		343.055		<0.001	1.106(1.094~1.118)
诊断单位类型
其他非定点医疗机构(参照组)								1.000
疾控中心/结防所等专业机构	0.180		0.005		1074.843		<0.001	1.197(1.184~1.210)
重症
否(参照组)								1.000
是	-0.072		0.006		128.739		<0.001	0.931(0.919~0.942)
治疗分类
初治(参照组)								1.000
复治	0.136		0.008		270.386		<0.001	1.146(1.127~1.164)

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