重庆市梁平县肺结核患者就诊延迟及其相关因素分析

Analysis of delayed health care seeking among patients with pulmonary tuberculosis in Liangping county of Chongqing and its relative factors

目的了解重庆市梁平县肺结核患者就诊延迟情况，探索与就诊延迟相关的主要因素。方法从结核病信息管理系统导出重庆市梁平县2005--2012年登记的结核病患者的个案资料共计3365例，采用描述性分析就诊延迟率；采用秩和检验分析不同性别、年龄、职业、患者来源、登记类型的就诊延迟是否有差异，以P〈0．05为差异有统计学意义；采用logistic回归分析性别、年龄、职业、患者来源、登记类型是否与就诊延迟相关（P〈0．05为差异有统计学意义）。结果重庆市梁平县肺结核患者就诊延迟率为73．14％（2461／3365），就诊延迟中位数为32d，有52．84％（1778／3365）的肺结核患者就诊延迟在1个月以上。职业、患者来源和登记类型与就诊延迟相关，农民就诊延迟高于其他职业（OR=1．513，95％CI=1．279～1．778，P〈0．05）；因症推荐患者就诊延迟高于转诊患者（OR=2．170，95％CI=1．798~2．618，P〈0．05）；复发患者就诊延迟高于新患者（OR=1．222，95％CI=0．9501．572，P〈0．05）。结论重庆市梁平县肺结核患者就诊延迟率高，就诊延迟与患者职业、来源和登记类型相关，建议采取综合有效措施，减少该地区的肺结核患者就诊延迟现象。

Objective To understand the situation of delay in seeking health care among patients with pulmo- nary tuberculosis （TB） in Liangping county of Chongqing, and to explore the relative factors of patients＇ delay. Methods The individual information of all pulmonary TB patients （3365 patients in total） notified in Liangping county of Chongqing from 2005 to 2012 were exported from the National TB Recording and Reporting （R＆R） Sys- tem. The rate of patients＇ delay in seeking health care was analyzed and described. Rank-sum test was used to ana- lyze the differences of patients＇ delay by sex, age and occupation of patient, as well as source of patient and type of TB; P〈0.05 was considered to have statistical significance. Logistic regression analysis was used to identify if the patients＇ delay was related to sex, age, occupation, source of patient and type of TB; the level of statistical signifi- cance was P〈0. 05. Results The overall rate of pulmonary TB patients＇ delay in seeking health care was 73.14% （2461/3365） in Liangping county of Chongqing, and the median of patients＇ delay was 32 days; the time of delayed health care seeking was more than one month in 52. 84% （1778/3365） of pulmonary TB patients. The delay was re- lated to occupation, source of patient and type of TB： the TB patients with occupation as farmer had the highest de- layed health care seeking compared with those in other occupations （OR = 1. 513, 95 % CI = 1. 279-- 1. 778, P〈 0.05） l compared with the patients who were referred by health facilities at county level, the patients who were re- ferred by township hospital or village doctors as TB suspects were more likely to delay in seeking health care （OR= 2. 170, 95%CI=1. 798--2. 618, P〈0.05）; and the relapsed TB patients were more likely to have delayed health care seeking compared with new patients （OR= 1. 222, 95 %CI= 1. 222--0. 950, P〈0.05）. Conclusion The rate of delayed health care seeking among patients with pulmonary TB was high in Liangping county of Chongqing, which was associated with patient＇s occupation, source of patient and type of TB. Effective measures should be taken to reduce the TB patients＇ delay.