上海市青浦区2011—2022年肺结核患者就诊延迟现状及影响因素

Current situation and influencing factors of health-care seeking delay among pulmonary tuberculosis patients in Qingpu district of Shanghai,2011-2022

目的分析2011—2022年上海市青浦区肺结核患者就诊延迟情况及影响因素,为结核病防控提供科学依据。方法通过“结核病信息管理系统”收集2011—2022年上海市青浦区肺结核患者病案信息,描述就诊延迟分布情况及变化趋势,采用χ^(2)检验进行单因素分析,采用趋势性χ^(2)检验进行率的时间趋势检验,多因素logistic回归模型分析患者就诊延迟的影响因素。结果2011—2022年青浦区肺结核患者3488例,就诊延迟1438例,就诊延迟天数M(P25,P75)为10(2,24)d,就诊延迟率为41.23%。2011—2022年每年的就诊延迟率在33.88%~50.45%,不同年份就诊延迟率差异有统计学意义(χ^(2)=38.355,P<0.001),且2020—2022年间就诊延迟率呈上升趋势(χ^(2)_(趋势)=13.290,P<0.001)。多因素logistic回归分析显示:与男性、年龄<25岁、户籍为本地、发现方式为健康体检相比,女性(OR=1.21,95%CI:1.04~1.41)、45~<65岁(OR=1.36,95%CI:1.06~1.75)、市内流动(OR=1.35,95%CI:1.09~1.68)、省间/境外流动(OR=1.50,95%CI:1.23~1.83)、直接就诊(OR=3.52,95%CI:2.27~5.47)、转诊(OR=2.07,95%CI:1.31~3.25)、推介(OR=2.16,95%CI:1.36~3.44)、追踪(OR=3.07,95%CI:1.74~5.44)的肺结核患者更容易发生就诊延迟,差异均有统计学意义(P<0.05);与痰检阳性相比,痰检阴性(OR=0.76,95%CI:0.59~0.97)的肺结核患者较不容易发生就诊延迟,差异有统计学意义(P<0.05)。结论上海市青浦区肺结核患者就诊延迟现象较为普遍,应针对危险因素和重点人群采取相应干预措施,进一步改善就诊延迟情况。

Objective To analyze the current situation and influencing factors of health-care seeking delay among pulmonary tuberculosis patients in Qingpu District of Shanghai from 2011 to 2022,and to provide a scientific basis for tuberculosis prevention and control.Methods The data of pulmonary tuberculosis patients in Qingpu District of Shanghai from 2011 to 2022 was collected through the China Tuberculosis Information Management System to describe the distribution and change trend of the delay in health-care seeking.Univariate analysiswas performed using the chi-square(χ²)test,and the time trend of rates was tested with the trend chi-square(trendχ²)test.Multivariate logistic regression model analyzed the influencing factors of the delay in health-care seeking.Results From 2011 to 2022,there were 3488 cases of pulmonary tuberculosis in Qingpu District,with 1438 patients experiencing health-care seeking delay.The median(quartile)number of days of delay was M(P_(25),P_(75))=10(2,24)days,and the rate of health-care seeking delay was 41.23%.The annual rate of health-care seeking delay fluctuated between 33.88%and 50.45%from 2011 to 2022,with statistically significant differences between different years(χ^(2)=38.355,P<0.001),and an upward trend in the health-care seeking delay rate was observed from 2020 to 2022(χ_(trend)^(2)=13.290,P<0.001).Multivariate logistic regression analysis showed that compared to male,those under 25 years old,with local household registration,and detected through health check-ups,females(OR=1.21,95%CI:1.04-1.41),those aged 45 to<65(OR=1.36,95%CI:1.06-1.75),intra-city migrants(OR=1.35,95%CI:1.09-1.68),inter-provincial/overseas migrants(OR=1.50,95%CI:1.23-1.83),and patients who directly sought medical care(OR=3.52,95%CI:2.27-5.47),transfer treatment(OR=2.07,95%CI:1.31-3.25),referral(OR=2.16,95%CI:1.36-3.44),follow-up(OR=3.07,95%CI:1.74-5.44)patients with pulmonary tuberculosis were more likely to delay health-care,and the differences were statistically significant(P<0.05).Compared to sputum-positive patients,those with sputum-negative tests(OR=0.76,95%CI:0.59-0.97)were less likely to experience delayed health-care,and the difference was statistically significant(P<0.05).Conclusions Health-care seeking delay of pulmonary tuberculosis patients is relatively common in Qingpu District of Shanghai.Corresponding intervention measures should be adopted for risk factors and key populations to further improve the health-care seeking delay.