苏州市流动人口与户籍人口结核病诊断延误状况及影响因素

Diagnosis delay of tuberculosis and its influencing factors among floating worker and local residents in Suzhou City

目的 了解苏州市流动人口与户籍人口结核病诊断延误状况及其影响因素,为制定结核病防治策略提供参考依据。方法 通过面对面问卷和查阅病例,调查2017年6月-2018年7月苏州市5个县区经结核病定点医院确诊的418例流动人口结核病患者和214例户籍人口结核病患者。运用非概率抽样法,采用专题小组讨论和个人深入访视方式进行定性分析。结果 定量调查中,流动人口和户籍人口结核病诊断间隔时间(中位数及四分位数)分别为21(8,44)天和16(5,32)天,差异有统计学意义(Z=3.13,P<0.05)。经多因素调整后,就诊次数>1(OR=3.343,95%CI=1.641~6.812,P<0.01)、首发症状-咯血(OR=0.268,95%CI=0.098~0.729,P<0.05)、首次检查-痰涂片(OR=0.283,95%CI=0.139~0.556,P<0.01)、首次检查-胸片(OR=0.409,95%CI=0.212~0.786,P<0.01)与户籍人口结核病发生诊断延误相关联。就诊次数>1(OR=3,626,95%CI=1.741~7.552,P<0.01)、首次检查-痰涂片(OR=0.395,95%CI=0.230~0.678,P<0.01)、首次检查-胸片(OR=0.367,95%CI=0.222~0.0.605;P<0.01)与流动人口结核病发生诊断延误相关联。定性研究中,流动人口结核病患者因经济困难、工作繁忙及高流动性等因素,较户籍人口更易发生诊断延误。结核病防治意识和知识差、医疗质量及医生责任心是诊断延误的影响因素。结论 苏州市流动人口结核病诊断延误较户籍人口严重。应加强健康宣教,重视医疗质量,完善转诊机制,增加经费投入等综合干预措施,减少结核病患者诊断延误的发生。

Objective To understand the distribution and relevant influencing factors of tuberculosis diagnosis delay among floating and local residents in Suzhou City,provide reference for formulating tuberculosis control strategy.Methods The face-toface questionnaires and case checks were used to investigate 418 floating patients with tuberculosis and 214 local residents with tuberculosis,who were confirmed by a designated hospital for tuberculosis in Five Counties and Districts in Suzhou City from June 2017 to July 2018.Using non-probability sampling,qualitative study was conducted with focus group discussion and indepth interview.Results In quantitative investigation,the diagnosis delay time(median and quartile)among floating and local residents were 21(8,44)days and 16(5,32)days,respectively,and difference was statistically significant(Z=3.13,P<0.05).After adjustment for multivariate,tuberculosis diagnosis delay among local residents was associated with visit number>1(OR=3.343,95%CI=1.641-6.812,P<0.01),onset symptom-hemoptysis(OR=0.268,95%CI=0.098-0.729,P<0.05),first examination-sputum smear(OR=0.283,95%CI=0.139-0.556,P<0.01),first examination-X-ray(OR=0.409,95%CI=0.212-0.786,P<0.01).The tuberculosis diagnosis delay among floating population was associated with visit number>1(OR=3.626,95%CI=1.741-7.552,P<0.01),first examination-sputum smear(OR=0.395,95%CI=0.230-0.678,P<0.01),first examination-Xray(OR=0.367,95%CI=0.222-0.605,P<0.01).In qualitative study,tuberculosis patients of floating population were more likely to suffer from diagnosis delay than local residents due to poor economy,busy work,and high mobility.Poor awareness and knowledge of tuberculosis control,medical quality,and doctor responsibility were factors to influence diagnosis delay.Conclusion Tuberculosis diagnosis delay among floating population is more serious than that among local residents in Suzhou City.It is necessary to carry out the comprehensive intervention measures,such as strengthening health education,attaching importance to medical quality,improving the referral mechanism,and increasing funding,to reduce the proportion of diagnosis delay.