2010-2019年北京市某定点医疗机构结核病患者就诊延迟影响因素分析

Analysis on influencing factors of tuberculosis patient delay in a designated medical institution of Beijing from 2010-2019

目的 分析 2010-2019 年北京市结核病控制研究所(市结控所)结核病患者就诊延迟变化趋势及影响因素,为北京市结核病防治措施的制定提供依据。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》导出 2010-2019 年市结控所确诊登记的 3 120 例结核病患者的信息,包括户籍、现住地、性别、年龄、民族、职业、患者来源、患者分类及并发症发生情况,采用单因素和多因素 logistic 回归模型分析结核病患者就诊延迟的影响因素。结果 2010-2019 年市结控所结核病患者从出现症状至就诊的天数 M(P_(25),P_(75))为 15(2,47)d,就诊延迟率为 50.10%(1 563/3 120)。2010-2019 年市结控所确诊登记的结核病患者就诊延迟率呈下降趋势(χ^(2)趋势=25.182,P<0.01)。就诊延迟者主要为男性,≥65 岁组所占的构成比逐渐增长。2010-2014 年诊断的结核病患者、本市户籍患者、≥65 岁组患者、离退休人员、因症就诊、肺外结核、病原学阳性的患者就诊延迟率较高,差异均有统计学意义(均 P<0.05)。多因素 logistic 回归分析结果显示,45~<65、≥65 岁[以<25 岁年龄组为对照,OR(95%CI)分别为 1.905(1.487~2.440)和 2.285(1.738~3.004)]、家政/家务/待业及其他职业患者[以学生及儿童为对照,OR(95%CI)分别为 1.429(1.023~1.996)和 1.564(1.141~2.144)]、因症就诊及其他来源患者[以接触者筛查为对照,OR(95%CI)分别为 6.844(1.572~29.792)和 17.958(2.471~130.507)]的结核病患者更容易出现就诊延迟。结论 2010-2019 年市结控所结核病患者就诊延迟现象较为普遍,高危因素包括年龄≥45 岁、家政/家务/待业及其他职业患者、因症就诊及其他来源患者。对上述就诊延迟的高危因素需要加强关注,对重点人群尤其是老年人群体定期进行主动筛查,减少就诊延误的发生。

Objective To analyze the trend and influencing factors of tuberculosis (TB)patient delay in Beijing Institute of Tuberculosis Control from 2010 -2019,provide scientific evidence for the development of prevention and control measures in Beijing.Methods The information of 3 120 TB patients registered in Beijing Institute of Tuberculosis Control from 2010-2019 was derived from the TB Management Information System,the subsystem of the Chinese Disease Control and Prevention Information System ,including registration,current residence,gender,age,ethnicity,occupation,source of patients,classification of patients and complications. The influencing factors of tuberculosis patient delay were analyzed by univariate and multivariate logistic regression.Results M(P_(25),P_(75)) from symptom onset to seeking health care was 15(2,47) days in patients in the Beijing Institute of Tuberculosis Control from 2010-2019,the rate of TB patients delayed in seeking health care was 50.10% (1 563/3 120). The rate of TB patients delayed in seeking health care in the Beijing Institute of Tuberculosis Control showed a decreasing trend from 2010 -2019(χ^(2)trend=25.182,P<0.01).The majority of patients with delayed treatment were male ,and the proportion of ≥65 years old group was gradually increasing. The rate of patients delayed in seeking health care were higher among TB patients diagnosed from2010 to 2014,patients with local household registration,patients ≥65 years old group,retirees,patients seeking medical treatment due to symptoms,extrapulmonary tuberculosis,and patients with positive etiology,and the differences were statistically significant(all P<0.05). Multivariate logistic regression analysis showed that TB patients with the following characteristics were more likely to experience a delay in seeing health care:age of 45-<65 and ≥65 years old[<25 years old as the reference group,OR (95%CI)were 1.905 (1.487-2.440) and 2.285 (1.738-3.004)respectively] ,housekeeping/housework/unemployed and other occupational patients[students and children as the reference group,OR(95%CI) were 1.429(1.023-1.996) and 1.564(1.141-2.144)respectively] ,and patients seeking medical treatment due to symptoms and from other sources [screening of contacts as the a reference ,OR(95%CI) were 6.844(1.572-29.792) and 17.958(2.471-130.507)respectively]. Conclusions The patients delayed in seeking health care is relatively common in the Beijing Institute of Tuberculosis Control from 2010-2019,and the high risk factors include≥45 years old,housekeeping/housework/unemployed and other occupational patients,as well as patients seeking medical treatment due to symptoms and from other sources. It is necessary to pay more attention to the above high risk factors of patient delay,and carry out regular active screening for focus groups,especially the elderly,to reduce the occurrence of patient delay.