关键词: 结核,肺, 糖尿病, 就诊延迟, 治疗结果, 因素分析,统计学, 贵州省

Abstract:

Objective: To investigate the prevalence of patient delay and adverse outcomes among individuals with pulmonary tuberculosis coexisting with diabetes mellitus (PTB-DM) in Guizhou Province and to analyze the associated influencing factors. The findings aim to provide evidence-based guidance for optimizing the management and control strategies of comorbid conditions. Methods: Medical records of 8123 PTB-DM patients registered and diagnosed in Guizhou Province between 2016 and 2023 were extracted from the “Tuberculosis Information Management System,” a component of the “National Tuberculosis Information Management System”. Joinpoint regression and binary logistic regression models were employed to assess trends in patient delay rates, adverse treatment outcomes, and their associated influencing factors. Results: From 2016 to 2023, the patient delay rate among PTB-DM patients was 65.74% (5340/8123), with a median delay time of 27 days (interquartile range: 10-65 days). No statistically significant differences were observed in delay rates across different years, ranging from 65.92% (265/402) to 71.52% (457/639) (AAPC=-1.314, 95%CI: -3.489-0.911, P=0.245). However, delay rates varied significantly across regions, ranging from 55.89% (318/569) to 70.44% (808/1147)(χ²=51.424, P<0.001). Notably, Anshun City exhibited a significant year-on-year increase in delay rates, from 40.00% (4/10) to 79.46% (89/112) (AAPC=6.302, 95%CI: 1.216-11.643, P=0.015). The incidence of adverse outcomes was relatively high at 10.56% (858/8123), although the yearly rates demonstrated a significant downward trend, ranging from 8.53% (185/2169) to 14.68% (59/402) (AAPC=-6.904, 95%CI: -9.716--4.004, P=0.001). Regional variations in incidence rates were also observed, ranging from 6.97% (80/1147) to 13.14% (147/1119)(χ²=35.262, P<0.001). Multivariate analysis identified several risk factors for patient delay, including being traced (OR: 1.160, 95%CI: 1.013-1.327), having comorbidities (OR: 1.380, 95%CI: 1.193-1.596), positive etiological findings (OR: 1.183, 95%CI: 1.065-1.316), undergoing retreatment (OR: 1.327, 95%CI: 1.126-1.563), and having tuberculosis in other systems (OR: 1.303, 95%CI: 1.133-1.497). In contrast, patients identified through health check-ups, active screening, or other proactive measures were less likely to experience delay (OR: 0.606, 95%CI: 0.448-0.820). Patients aged 36-64 years, ≥65 years, those with comorbidities, undergoing retreatment, and with positive etiological findings were identified as significant risk factors for adverse outcomes, with odds ratios (95%CI) of 1.724 (1.088-2.734), 2.903 (1.816-4.641), 1.324 (1.090-1.609), 1.439 (1.161-1.784), and 1.386 (1.159-1.657), respectively. Conversely, students and individuals employed in occupations such as the catering and service industries were protective against adverse outcomes, with an odds ratio (95%CI) of 0.480 (0.292-0.788). Conclusion: Between 2016 and 2023, the overall rate of patient delay among PTB-DM patients in Guizhou Province remained stable and was comparable to that observed in the general population of pulmonary tuberculosis patients in the region. However, the rising delay rates in Anshun City warrant particular attention. Although adverse outcomes exhibited a consistent year-on-year decline, they remained higher than those in the general pulmonary tuberculosis population. Strengthened prevention and management efforts are urgently needed for PTB-DM patients, with a focus on those with comorbidities, positive etiological findings, undergoing retreatment, presenting with tuberculosis in other systems, or aged ≥36 years, to effectively mitigate patient delays and improve treatment outcomes.

Key words: Tuberculosis, pulmonary, Diabetes, Patient delay, Treatment outcome, Factor analysis, statistical, Guizhou Province