Status and influencing factors of diagnosis and treatment delay of rifampicin resistant pulmonary tuberculosis patients, Jilin Province, 2020—2023

doi:10.19982/j.issn.1000-6621.20240530

Abstract

Abstract:

Objective: To analyze diagnosis and treatment delay and their related influencing factors among rifampicin-resistant tuberculosis (RR-TB) patients in Jilin Province, aiming to provide a reference basis for developing prevention and control measures in Jilin Province. Methods: Medical records on RR-TB patients from 2020 to 2023 were extracted from the Tuberculosis Management Information System, a subsystem of the China Disease Prevention and Control Information System. Trends of diagnosis and treatment delay rates over time were analyzed using trend chi-square test, and logistic regression model was used to examine the related influencing factors. Results: Among 1931 RR-TB patients, their health-care seeking delay rate, definitive diagnosis delay rate and treatment delay rate were 50.7% (979/1931), 12.7% (245/1931) and 25.4% (491/1931), respectively. From 2020 to 2023, the rate of definitive diagnosis delay increased ($χ^{2}_{trend}$=12.353,P<0.001), while the rate of treatment delay decreased ($χ^{2}_{trend}$=33.459,P<0.001). Logistic regression model showed that patients being detected by primary care units recommending to TB designated hospital (OR=0.443, 95%CI:0.241-0.817) and patients being relapse (OR=0.818, 95%CI:0.680-0.984) were protective factors for health-care seeking delay, comorbidity (OR=1.312, 95%CI:1.080-1.721) and multi-drug resistance (OR=1.252, 95%CI:1.035-1.515) were risk factors for health-care seeking delay. Patients were detected through general hospital referring to TB designated hospital (OR=2.184, 95%CI:1.568-3.042) and TB designated hospital tracing (OR=1.946, 95%CI:1.390-2.724) were risk factors for definitive diagnosis delay, molecular biological rapid testing (OR=0.140, 95%CI:0.072-0.273)and diagnosed in provincial or municipal medical institutions (OR=0.072, 95%CI:0.049-0.107) were protective factors for definitive diagnosis delay. Molecular biological rapid detection (OR=0.420, 95%CI:0.136-0.501) was a protective factor for treatment delay, relapse patients (OR=1.259, 95%CI:1.019-1.555) and floating population (OR=1.907, 95%CI:1.275-2.852) were risk factors for treatment delay. Conclusion: The risks of diagnosis and treatment delays in Jilin Province were relatively high. In order to further reduce these delay, corresponding prevention and control measures for high-risk factors should be taken.

Key words: Tuberculosis, Rifampin, Drug tolerance, Factor analysis, statistical, Jilin Province

CLC Number:

R521

Jiang Xue, Bai Yunlong, Ma Jianjun, An Yuan, Yang Fan, Zhao Qinglong. Status and influencing factors of diagnosis and treatment delay of rifampicin resistant pulmonary tuberculosis patients, Jilin Province, 2020—2023[J]. Chinese Journal of Antituberculosis, 2025, 47(4): 416-424. doi: 10.19982/j.issn.1000-6621.20240530

Figures/Tables 6

年份	患者例数	就诊延迟		确诊延迟		治疗延迟
年份	患者例数	就诊时间间隔 [d,M(Q₁,Q₃)]	就诊延迟率 (%)	确诊时间间隔 [d,M(Q₁,Q₃)]	确诊延迟率 (%)	治疗时间间隔 [d,M(Q₁,Q₃)]	治疗延迟率 (%)
2020	509	13(2,39)	46.8	1(0,5)	9.2	4(1,12)	34.2
2021	515	16(3,46)	53.0	2(0,6)	8.3	4(1,9)	28.9
2022	350	18(5,59)	54.9	3(0,14)	23.4	0(0,1)	13.7
2023	557	14(5,46)	49.6	2(0,8)	13.1	0(0,5)	21.5
$χ 趋势 2$ 值			0.728		12.353		33.459
P_趋势值			0.393		<0.001		<0.001

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
发现方式
直接就诊					1.000
体检	-0.675	0.633	1.137	0.286	0.509(0.147~1.761)
推介	-0.813	0.312	6.794	0.009	0.443(0.241~0.817)
转诊	0.077	0.123	0.396	0.529	1.080(0.849~1.375)
追踪	0.013	0.121	0.012	0.912	1.013(0.799~1.285)
治疗分类
初治					1.000
复治	-0.201	0.094	4.551	0.033	0.818(0.680~0.984)
并发症
否					1.000
是	0.271	0.138	3.838	0.045	1.312(1.080~1.721)
耐药类型
单耐利福平					1.000
耐多药	0.225	0.097	5.365	0.021	1.252(1.035~1.515)

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
发现方式
直接就诊					1.000
体检				0.990	0.000
推介	-1.056	0.740	2.038	0.153	0.348(0.082~1.483)
转诊	0.781	0.169	21.373	<0.001	2.184(1.568~3.042)
追踪	0.666	0.172	15.061	<0.001	1.946(1.390~2.724)
检测方法
传统药物敏感性试验					1.000
分子生物学检测	-1.968	0.341	33.242	<0.001	0.140(0.072~0.273)
首诊单位级别
市级以下基层机构					1.000
省市级机构	-2.626	0.201	171.245	<0.001	0.072(0.049~0.107)

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
重点人群
否					1.000
是	-0.190	0.245	0.601	0.438	0.827(0.512~1.337)
户籍类型
当地居民					1.000
流动人口	0.645	0.205	9.865	0.002	1.907(1.275~2.852)
治疗分类
初治					1.000
复治	0.230	0.108	4.557	0.033	1.259(1.019~1.555)
合并症
否					1.000
是	-0.235	0.281	0.702	0.402	0.791(0.456~1.370)
检测方法
传统药物敏感性试验					1.000
分子生物学检测	-1.344	0.333	16.318	<0.001	0.420(0.136~0.501)
首诊单位级别
市级以下基层机构					1.000
省市级机构	-0.097	0.132	0.549	0.459	0.907(0.701~1.174)

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