2016-2022年重庆都市圈肺结核患者就诊延迟特征及影响因素分析  

Analysis on medical care seeking delay in pulmonary tuberculosis patients and influencing factors in Chongqing metropolitan area,2016-2022

作　　者：税义超 张婷 钟吉元 张军[3] 贺月 蒲川[1] Shui Yichao;Zhang Ting;Zhong Jiyuan;Zhang Jun;He Yue;Pu Chuan(Research Center for Medicine and Social Development,School of Public Health,Chongqing Medical University Chongqing 400016,China;Chongqing Tuberculosis Prevention and Control Institute,Chongqing 400050,China;Guang'an Prefectural Center for Disease Control and Prevention,Guang'an 638500,Sichuan,China)

机构地区：[1]重庆医科大学公共卫生学院,医学与社会发展研究中心重庆400016 [2]重庆市结核病防治所,重庆400050 [3]广安市疾病预防控制中心,四川广安638500

出　　处：《疾病监测》2024年第10期1282-1287,共6页Disease Surveillance

基　　金：重庆市科卫联合医学科研项目(No.2023MSXM053);重庆市科卫联合医学科研项目(No.2024ZDXM020);重庆市科学技术局项目(No.cstc2021jsyj-zzysbAX0066)。

摘　　要：目的描述2016—2022年重庆都市圈肺结核患者就诊延迟特征并分析其影响因素,为重庆都市圈肺结核防控提供依据。方法从中国疾病预防控制信息系统的子系统结核病信息管理系统中导出2016—2022年重庆市和广安市登记的敏感肺结核患者病案数据,包括年龄、性别、职业、民族、患者来源、并发症、治疗分类、现住址、症状出现日期、首次就诊日期、登记日期、户籍地址类别、重点人群、现诊断地区等。采用中位数及四分位数间距进行统计描述,就诊延迟率随时间变化的趋势采用χ^(2)趋势性检验,就诊延迟影响因素采用χ^(2)检验和logistic回归分析模型。结果2016—2022年重庆都市圈肺结核患者就诊延迟天数中位数为29(9,62)d,年均就诊延迟率为67.11%(81070/120807),且就诊延迟率呈逐年下降趋势(趋势χ^(2)=244.650,P<0.01)。渝东北区(73.98%)与渝东南区(70.72%)地区就诊延迟率远高于其他地区(χ^(2)=1877.018,P<0.001)。外地户籍[比值比(OR)=1.08,95%置信区间(CI):1.04~1.12]、被动发现(OR=5.56,95%CI:5.07~6.11、有合并症(OR=1.13,95%CI:1.10~1.16)、26~39岁(OR=1.14,95%CI:1.08~1.20)、40~54岁(OR=1.42,95%CI:1.35~1.49)、55~64岁(OR=1.50,95%CI:1.41~1.59、≥65岁(OR=1.3895%CI:1.31~1.47、重点人群(OR=0.94,95%CI:0.90~0.98)、职业[学生(OR=0.56,95%CI:0.53~0.60、工人(OR=0.88,95%CI:0.83~0.940、家务及待业(OR=0.83,95%CI:0.80~0.87、离退人员(OR=0.86,95%CI:0.80~0.92、其他(OR=0.65,95%CI:0.620~0.68]均为就诊延迟影响因素。结论重庆都市圈肺结核患者就诊延迟率逐年下降,各地的肺结核患者就诊延迟时间和就诊延迟率有较大差异,这与不同地区医疗服务水平,医疗可及性,经济交通发展状况以及发病水平有关。户籍地址、患者来源、合并症、年龄、重点人群、职业等均为就诊延迟影响因素,应对不同因素采取针对性措施。Objective To describe the characteristics of delayed medical care seeking in pulmonary tuberculosis(TB)patients and influencing factors in Chongqing metropolitan area,which covers Chongqing municipality and Guang'an prefecture of Sichuan province,from 2016 to 2022,and provide evidence for pulmonary TB prevention and control in this area.Methods The medical records data of drug sensitive pulmonary TB patients registered in Chongqing and Guang'an during 2016-2022,including age,gender,occupation,patient source,complication,treatment type,current address,onset date,the first medical care seeking date,registration date,household registration type,key population and area bring diagnosed,were extracted from the Tuberculosis Information Management System,a subsystem of China Disease Prevention and Control Information System.The median and interquartile intervals were used for statistical description.The trend in medical care seeking delay over time was analyzed withχ^(2) test.The influencing factors for medical care seeking delay were analyzed withχ^(2)test and Logistic regression model.Results The median delay of medical care seeking was 29(9,62)days in pulmonary TB patients in Chongqing metropolitan area from 2016 to 2022,and the average annual delay rate was 67.11%(81070/120807),and the delay rate showed a decreasing trend year by year(trendχ^(2)=244.650,P<0.01).The delay rates were much higher in northeast Chongqing(73.98%)and southeast Chongqing(70.72%)than in others(χ^(2)=1877.018,P<0.001).Being resident from other area odds ratio(OR)=1.08,95%confidence interval(CI):1.04–1.12,passive detection(OR=5.56,95%CI:5.07–6.11),comorbidity(OR=1.13,95%CI:1.10–1.16),age 26–39 years(OR=1.14,95%CI:1.08–1.20),age 40–54 years(OR=1.42,95%CI:1.35–1.49,age 55–64 years(OR=1.50,95%CI:1.41–1.59,age≥65 years(OR=1.38,95%CI:1.31–1.47,being in key population(OR=0.94,95%CI:0.90–0.98,occupation[student(OR=0.56,95%CI:0.53–0.60),workers(OR=0.88,95%CI:0.83–0.94),unemployment or jobless(OR=0.83,95%CI:0.80–0.87),b

关 键 词：重庆都市圈 肺结核 就诊延迟 影响因素 

分 类 号：R211[医药卫生—中医学] R521