2017—2022年海安地区肺结核患者复发及延迟就诊影响因素分析

Factors influencing recurrence and delayed treatment of pulmonary tuberculosis patients in Hai’an area,2017-2022

目的探索海安地区肺结核患者复发及延迟就诊影响因素,为该地区肺结核防治工作提供参考依据。方法通过基层结核病预防管理信息系统筛选2017—2022年海安地区登记的肺结核患者,根据治疗分类将患者分为未复发组和复发组,根据就诊天数将患者分为未延迟就诊组和延迟就诊组,对比相应组间患者一般资料差异,采用多因素logistic回归分析影响肺结核患者复发及延迟就诊的相关因素。结果2017—2022年登记的肺结核患者共1263例,肺结核复发78例,复发率为6.18%;共有延迟就诊754例,延迟就诊率为59.70%。相较于未复发组,复发组平均年龄更大、病原学阳性病例比例更高、流动人口比例更高,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄越大(OR=1.020,95%CI:1.005~1.036)、病原学阳性(OR=6.151,95%CI:3.682~10.273)、流动人口(OR=1.736,95%CI:1.030~2.927)是影响肺结核复发的危险因素;相较于未延迟就诊组,延迟就诊组年龄更大,流动人口比例更高、文化程度和家庭年收入水平更低,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄越大(OR=1.011,95%CI:1.004~1.018)、流动人口(OR=2.707,95%CI:1.305~5.613)是影响肺结核延迟就诊的危险因素,本科及以上学历(OR=0.104,95%CI:0.042~0.254)、家庭年收入>3万(家庭年收入3~7万元OR=0.849,95%CI:0.763~0.946;家庭年收入>7万元OR=0.356,95%CI:0.202~0.628)有利于促进肺结核患者及时就诊。结论2017—2022年海安地区肺结核复发率及延迟就诊率相对较高,预防复发并促进患者及时就诊需重点关注高龄及流动人口群体,加强面向低文化水平群体的防病教育以及降低患者可能面临的治疗经济负担,可有效促进该地区肺结核患者及时就诊。

Objective To explore the factors affecting recurrence and delayed treatment of patients with pulmonary tuberculosis in Hai’an area,and to provide references for pulmonary tuberculosis prevention and treatment in local area.Methods Pulmonary tuberculosis patients registered in Hai’an area from 2017 to 2022 were screened based on the Primary Tuberculosis Prevention and Management Information System.The patients were divided into the non-recurrence group and the recurrence group according to treatment classification.The patients were divided into the non-delayed treatment group and the delayed treatment group according to the days of treatment.The differences in the general data of patients between the corresponding groups were compared.Multivariate logistic regression analysis was performed to identify the related factors affecting recurrence and delayed treatment of the pulmonary tuberculosis patients.Results A total of 1,263 patients with pulmonary tuberculosis were registered from 2017 to 2022,78 patients had recurrence of pulmonary tuberculosis,with the recurrence rate of 6.18%.A total of 754 patients had delayed presentation,with the delayed presentation rate of 59.70%.Compared with the non-recurrence group,the recurrence group had a higher mean age,a higher proportion of etiologically positive cases and a higher proportion of migrants,showing statistically significant differences(P<0.05).Multivariate logistic regression analysis revealed that older age(OR=1.020,95%CI:1.005-1.036),positive etiology(OR=6.151,95%CI:3.682-10.273),and floating population(OR=1.736,95%CI:1.030-2.927)were risk factors affecting recurrence of pulmonary tuberculosis.Compared with the group without delayed presentation,the delayed presentation group was older,and had a higher proportion of floating population and lower levels of education background and annual family income,with statistically significant differences(P<0.05).Multivariate logistic regression analysis displayed that older age(OR=1.011,95%CI:1.004-1.018)and floating population(OR=2.707,95%CI:1.305-5.613)were risk factors affecting delayed presentation of pulmonary tuberculosis.Bachelor degree or above(OR=0.104,95%CI:0.042-0.254)and annual family income>30,000(annual family income 30,000-70,000 yuan(OR=0.849,95%CI:0.763-0.946);annual family income>70,000 yuan(OR=0.356,95%CI:0.202-0.628))were beneficial to promoting the pulmonary tuberculosis patients’timely presentation.Conclusion The recurrence rate and delayed treatment rate of pulmonary tuberculosis in Hai’an area in 2017-2022 were relatively high.It is necessary to pay special attention to the elderly and floating population so as to prevent recurrence and promote the patients’timely treatment.Strengthening the disease prevention education for the low education level group and reducing the patients’possible economic burden of treatment can effectively promote timely treatment of the pulmonary tuberculosis patients in Hai’an area.