武汉市社区肺结核可疑症状者就诊延误情况及其影响因素分析

The Study on Delay in Seeking Health Care and Its Influencing Factors among Community TB Suspects in Wuhan City

目的:了解武汉市社区肺结核可疑症状者的就诊延误情况及其影响因素,为促进社区肺结核可疑症状者及时就诊制定相应的措施。方法:结合全国第五次结核病流行病学调查现场和武汉市第五次结核病流行病学调查现场,从中筛选出在调查前6个月内连续咳嗽、咳痰两周以上或咯血、痰中带血者作为调查对象,进行面访式问卷调查。结果:Kruskal-Wallis检验和Mann-Whitney检验结果显示,影响社区肺结核可疑症状者就诊延误的因素有年龄、职业、户籍、结核病认知评分和咯血(<0.05);Cox回归分析显示,影响社区肺结核可疑症状者正式就诊延误的因素有医保、慢性呼吸道疾病、咯血和呼吸困难,其相应的RR(95%CI)分别为3.633(1.286-10.258)、2.212(1.290-3.793)、4.608(2.288-9.280)和2.524(1.411-4.514)。结论:武汉市社区肺结核可疑症状者的就诊存在一定程度的延误,医保、初次出现症状的严重程度及慢性呼吸道疾病是影响肺结核可疑症状者正式就诊延误的主要因素。

Objective： To investigate the seeking health care delay and identify the influencing factors of delay among community TB suspects in Wuhan city, and to develop appropriate measures for promoting timely treatment of community TB suspects. Methods： Based on the fifth national tuberculosis epidemiology survey and the fifth Wuhan city tuberculosis epidemiology survey, people who with continuous cough, sputum more than two weeks or hemoptysis, sputum with blood in the six months before survey were selected, then face to face interviews were conducted. Results： Kruskal-Wallis test and Mann-Whitney test shows that, age, household registration, occupation, TB cognitive score and hemoptysis were associated with the delay （P〈0.05）; Cox regression analysis shows that TB suspects, who with health insurance, chronic respiratory diseases, hemoptysis and difficulty breathing had a shorter delay to seek health care at primary health center or general hospitals. The RR （95%CI） were 3.633 （1.286-10.258）, 2.212（1,290-3.793）, 4.608（2.288-9.280） and 2.524（1.411-4,514）, respectively. Con- clusions： There was a certain delay in seeking health care among community TB suspects in Wuhan city, health insurance, the severity of initial symptoms and with chronic respiratory diseases were the main factors of seeking health care among community TB suspects.