武汉市2011-2018年学生结核病患者就诊延迟及影响因素

Delay in treatment and influencing factors of student tuberculosis patients in Wuhan from 2011 to 2018

目的了解2011-2018年武汉市学生结核病患者就诊延迟情况及影响因素,为改进学校结核病防控措施提供参考依据。方法利用国家结核病管理信息系统2011-2018年录入的武汉市学生结核病患者病案信息,分析学生结核病患者的就诊延迟情况和变化趋势,并采用Logistic回归进行影响因素分析。结果武汉市学生结核病患者就诊天数中位数为9(3,21) d,51.14%的结核病患者存在就诊延迟。2011-2018年学生结核病患者的就诊延迟率总体呈先缓慢下降后逐步上升趋势,从2011年最高的56.4%,下降到2014年最低的45.6%,然后逐步上升到2018年的53.8%,前、后4年就诊延迟率差异无统计学意义(χ^2=2.84,P=0.09);不同性别患者的就诊延迟率与总体一致,女生波动稍明显,但差异无统计学意义(χ^2=0.07,P>0.05);不同年龄组中,13~18岁就诊延迟率最低(χ^2=87.23,P<0.01),19~22岁和不同学校级别大学组就诊延迟率呈现缓慢下降,其他年龄组和其他学校级别组呈总体上升趋势。多因素Logistic回归分析结果显示,远城区(OR=1.84,95%CI=1.56~2.16)、少数民族(OR=2.73,95%CI=1.46~5.09)和13~18岁(OR=0.57,95%CI=0.33~1.00)为影响学生就诊延迟率的主要因素。结论武汉市学生结核病患者就诊延迟总体情况不容乐观,超过一半的学生患者存在就诊延迟,远城区和少数民族学生为影响就诊延迟率高的主要因素。因时因地因人地采取有针对性的防控措施引导学生积极就诊非常重要。

Objective To understand delay in treatment student tuberculosis( TB) patients in Wuhan from 2011 to 2018,and to provide a reference for prevention and control measures of tuberculosis in schools.Methods The medical cases of students with tuberculosis in Wuhan recorded by the national tuberculosis management information system during 2011-2018 were analyzed for the delay and change trend of medical treatment of students with tuberculosis,and Logistic regression was used to analyze influencing factors.Results The median number of student TB patients seeking treatment in Wuhan was 9( 3,21) days,and 51.14%of student TB patients were delayed.From 2011 to 2018,the overall delay rate of TB patients in students decreased slowly and then gradually increased,decrea sing from the highest rate( 56.4%) in 2011 to the lowest one( 45.6%) in 2014,and then gradually increased to 53.8% in 2018,there was no significant difference in the delay rate between the first and the second four years( χ^2=2.84,P = 0.09);The delay rate of different gender students was the same as that of the whole.The fluctuation of female students was slightly obvious,but the difference was not statistically significant( χ^2= 0.07,P> 0.05);Among the students of different age groups,the delay rate of 13-18 years old was the lowest( χ^2= 87.23,P<0.01).The delay rate of 19-22 years old and university groups of different school levels showed a slow decline,while that of other age groups and other school level groups showed an overall upward trend.The results of multivariate logistic regression analysis showed that the main factors affecting the delay rate of medical treatment were the remote urban area( OR = 1.84,95% CI = 1.56-2.16),the ethnic minorities( OR = 2.73,95% CI = 1.46-5.09) and the age of 13-18( OR = 0.57,95%CI = 0.33-1.00).Conclusion Delay in treatment of TB patients in Wuhan is not optimistic,with more than half of the students have delayed in treatment,the main factors that affect the high rate of TB patients’ treatment delay are the students in the far urban areas and ethnic minorities.It is very important to take targeted prevention and control measures to guide the students to actively seek medical treatment according to the time,the place and the person.