甘肃省肺结核就诊和诊断延误分析:2016-2022年监测  

Medical facility visit and diagnosis delays of tuberculosis patients in Gansu based on surveillance during 2016-2022

作　　者：李佳琛 赵剑喜[2] 白玉娥[2] 张岚 Li Jiachen;Zhao Jianxi;Bai Yu'e;Zhang Lan(School of Public Health,Gansu University of Traditional Chinese Medicine,Lanzhou 730000,Gansu,China;Department of Tuberculosis Control,Gansu Center for Disease Control and Prevention,Lanzhou 730000,Gansu,China;Tuberculosis Prevention and Control Institute,Beijing Center for Disease Control and Prevention,Beijing 100035,China)

机构地区：[1]甘肃中医药大学公共卫生学院,甘肃兰州730000 [2]甘肃省疾病预防控制中心结核病防治科,甘肃兰州730000 [3]北京市疾病预防控制中心结核病预防控制所,北京100035

出　　处：《疾病监测》2024年第4期412-419,共8页Disease Surveillance

基　　金：甘肃省科技计划(创新基地和人才计划)项目(No.20JR10RA417和No.21JR11RA184)。

摘　　要：目的分析2016—2022年甘肃省肺结核患者就诊和诊断延误情况,了解相关影响因素,为制定和调整肺结核防治措施提供科学依据。方法在全国结核病信息管理系统中选择登记日期在2016—2022年且确诊地区为甘肃省的50606例肺结核患者,采用单因素χ2检验和多因素logistic回归分析就诊及诊断延迟的可能影响因素。结果2016—2022年甘肃省报告的50606例肺结核患者当中,首次出现症状到去医疗机构就医的平均时间为64.44 d,14 d内就诊的患者仅占27.86%;首次就诊到医生确诊的平均时间为6.88 d,14 d内确诊的患者占91.12%。对于就诊时间在7 d内的患者,就诊时间为7~14 d、15~30 d和31~60 d的19~45岁患者[比值比(OR)=1.16,95%置信区间(CI):1.07~1.26;OR=1.24,95%CI:1.16~1.33;OR=1.29,95%CI:1.20~1.38]的延误率均高于60岁以上患者;治疗分类为初治(OR=1.25,95%CI:1.02~1.53;OR=1.55,95%CI:1.28~1.86;OR=1.65,95%CI:1.37~1.98)是延误发生的危险因素;患者来源为健康检查(OR=0.65,95%CI:0.47~0.89;OR=0.30,95%CI:0.21~0.44;OR=0.30,95%CI:0.20~0.45)是延误发生的保护因素。在不同的诊断时间内,>60岁患者都是全年龄段中诊断延误的危险系数最高的人群;汉族的诊断延误情况没有少数民族患者严重(OR=0.88,95%CI:0.78~0.98;OR=0.88,95%CI:0.68~0.91;OR=0.59,95%CI:0.49~0.71;OR=0.66,95%CI:0.52~0.84);诊断时间为15~30 d、31~60 d和60 d以上的不同患者来源中,追踪(OR=1.59,95%CI:1.28~1.97;OR=2.49,95%CI:1.83~3.40;OR=2.44,95%CI:1.64~3.62)和健康检查(OR=2.55,95%CI:1.76~3.69;OR=2.17,95%CI:1.22~3.85;OR=2.13,95%CI:1.27~3.12)均为危险因素;诊断时间为15~30 d和31~60 d的本地人口相对于流动人口来说具有更小的诊断延误概率(OR=0.73,95%CI:0.62~0.87;OR=0.74,95%CI:0.65~0.84),差异均有统计学意义(P<0.05)。结论甘肃省肺结核患者就诊和诊断延误形势仍然严峻,终结结核诊治延误的工作任重道远。在加大结核防治宣传力度的同时,更需要医务人员提高对�Objective To analyze the consultation and diagnostic delays of tuberculosis(TB)patients and influencing factors in Gansu province from 2016 to 2022,and provide scientific basis for formulating and adjusting TB prevention and treatment measures.Methods The information of 50606 TB patients diagnosed in Gansu between 2016 and 2022 were collected from National Tuberculosis Information Management System,and the possible influencing factors of medical facility visit and diagnosis delays were analyzed by using the one-wayχ2 test and multivariate logistic regression.Results In the 50606 TB patients reported in Gansu during 2016−2022,the average interval between the first onset of symptoms and the medical facility visit was 64.44 days,and only 27.86%of the patients saw doctors within 14 days.The average interval between the first medical facility visit and the diagnosis was 6.88 days,and 91.12%of patients were diagnosed within 14 days.Compared with the patients who visited medical facilities within 7 days,more patients visited medical facilities within 7−14 days,15−30 days and 31-60 days in age group 19~45 years compared with age group>60 years(OR=1.16,95%CI:1.07–1.26;OR=1.24,95%CI:1.16–1.33;OR=1.29,95%CI:1.20–1.38).In these patients,being newly detected TB patient was the risk factor for medical facility visit delay(OR=1.25,95%CI:1.02−1.52;OR=1.55,95%CI:1.28–1.86;OR=1.65,95%CI:1.37−1.98),and being TB patient detected in health screening was the protective factor for medical facility visit delay(OR=0.65,95%CI:0.47–0.89;OR=0.30,95%CI:0.21–0.44;OR=0.30,95%CI:0.20–0.45).The patients aged>60 years had the highest hazard ratio for diagnosis delay in all age groups.The patients in Han ethnic group had less diagnosis delays compared with the patients in minor ethnic group(OR=0.88,95%CI:0.78–0.98;OR=0.88,95%CI:0.68–0.91;OR=0.59,95%CI:0.49−0.71;OR=0.66,95%CI:0.52−0.84);and in the patients from different sources,the risk factors for diagnosis delay included follow-up(OR=1.59,95%CI:1.28−1.97;OR=2.4

关 键 词：结核 肺 就诊延误 诊断延误 影响因素 

分 类 号：R211[医药卫生—中医学] R521