Abstract:

Objective　To analyze the characteristics of diagnosis and treatment delay of patients with tuberculosis in recent years at Yuexiu, and to provide the basic basis for the formulation of control strategies for the early detection of tuberculosis cases and the optimization and improvement of the implementation measures. Methods　The online reporting data of tuberculosis patients at Yuexiu District, Guangzhou from 2018 to 2022 were derived from the Tuberculosis Management Information System of China Information System for Disease Control and Prevention. Whether the intervals between the first diagnosis date and present symptom date and between the present diagnosis date and the present first diagnosis date were over 14 days were referred to as delay in seeing a doctor and diagnosis delay, respectively. The data of these two kinds of delay were statistically analyzed by day, week, month, and year. And the delays between male and female, between the juvenile group (< 18), the youth group (18-45), the middle-aged group (45-60), and the elderly group (≥60), and between the delay of each street were compared. χ² test and rank sum test were applied. Results　In the 2 504 cases of pulmonary tuberculosis, the rates of delay in seeing a doctor and diagnosis delay were 41.5% (1 028/2 504) and 30.71% (769/2 504), respectively. The ranges and medians of the two kinds of delays were 1-7 664 days and 27 days and 1-1 100 days and 14 days, respectively; the percentages of delay for one month, one year, and over one year were 52.72% (542/1 028), 43.29% (445/1 028), and 3.99% (41/1 028) and 77.76% (598/769), 21.59% (166/769), and 0.65% (5/769), respectively. The delay in seeing a doctor and diagnosis delay occurred in 662 cases (40.89%) and 482 cases (29.96%) among the 1 619 male patients, respectively, while 366 cases (41.36%) and 287 cases (32.43%) experienced the delays among the 885 female patients, respectively, with no statistical differences between the males and the females (all P˃0.05). The rates of delay in seeing a doctor and diagnosis delay in the juvenile group, the youth group, the middle-aged group, and the elderly group were 36.36% (16/44), 38.31% (321/838), 41.81% (268/641), and 43.12% (423/981) and 31.82% (14/44), 33.77% (283/838), 28.55% (183/641), and 29.46% (289/981), respectively, with no statistical differences (all P˃0.05). In the 18 sub-districts of Yuexiu District, the ranges of the rates of delay in seeing a doctor and diagnosis delay were 32.91%-50.79% and 21.52%-34.73%, respectively, with statistical differences (U=96.0 and 41.5; both P<0.05). Conclusions　There are high proportions of delay in seeing a doctor and diagnosis delay among patients with pulmonary tuberculosis at Yuexiu District. How to shorten delay in seeing a doctor by strengthening the active case finding and to reduce diagnosis delay by improving clinical diagnosis and treatment is an urgent problem to be solved.

Key words:

Pulmonary tuberculosis, Delay in seeing a doctor, Diagnosis delay, Guangzhou

摘要：

目的　分析本地区近年来肺结核患者诊疗延误情况特点，为结核病例尽早发现的控制策略制定和实施措施的优化完善提供基础性依据。方法　从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中导出广州市越秀区2018—2022年结核患者网报资料，分别以“本次首诊日期”与“本次症状出现日期”“本次确诊日期”与“本次首诊日期”之间的间隔时间是否大于14 d为就诊延误、诊断延误的临界点，以天、周、月、年为单位统计分析延误情况，并对性别、老中青少年［少年（<18岁）、青年（18～45岁）、中年（≥45～60岁）、老年（≥60岁）］、各街道的延误情况进行比较，应用χ²检验或秩和检验。结果　（1）2 504例肺结核患者中，就诊延误、诊断延误率分别为41.5%（1 028/2 504）、30.71%（769/2 504），两种延误时间范围与中位数分别为1～7 664 d、27 d和1～1 100 d、14 d，延误1个月、1年、1年以上分别为52.72%（542/1 028）、43.29%（445/1 028）、3.99%（41/1 028）和77.76%（598/769）、21.59%（166/769）、0.65%（5/769）。（2）在1 619例男性患者中，662例（40.89%）、482例（29.97%）患者分别发生就诊延误、诊断延误，885例女性患者中则分别为366例（41.36%）、287例（32.43%），差异均无统计学意义（均P>0.05）。（3）少、青、中、老年组患者的就诊延误率、诊断延误率分别为36.36%（16/44）、38.31%（321/838）、41.81%（268/641）、43.12%（423/981）和31.82%（14/44）、33.77%（283/838）、28.55%（183/641）、29.46%（289/981），差异均无统计学意义（均P>0.05）。（4）在辖区18个街道中，就诊延误率、诊断延误率分别在32.91%～50.79%和21.52%～34.73%之间，差异均有统计学意义（U=96.0、41.5，均P<0.05）。结论　本地区肺结核患者存在高比例的就诊延误和诊断延误，如何加强病例主动发现以缩短就诊延误和提高临床诊疗水平以减少诊断延误是亟待解决的重要问题。

关键词:

肺结核, 就诊延误, 诊断延误, 广州