Duration and Determinants of Delayed Diagnosis with Tuberculosis in Shenzhen, China: A Cross-Sectional Study

Abstract

Youli Jiang,1,* Lan Luo,2,3,* Min Gui,1 Linlin Liu,1 Yi Lin,2,3 Guofang Deng,2,3 Jingfang Chen,1,3 Peize Zhang2,3 1Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China; 2Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China; 3National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingfang Chen; Peize Zhang, Email [email protected]; [email protected]: Early diagnosis and timely treatment of tuberculosis are critical for disease control and management. However, diagnostic delay remains severe around the world. We aim to evaluate the duration and factors associated with diagnostic delay of tuberculosis in Shenzhen, China.Methods: We conducted a face-to-face interview to collect the whole care-seeking process of patients diagnosed with active TB in Shenzhen, China, from April 1 to September 30, 2021. The duration from symptom onset to confirmed diagnosis was recorded. The risk factors of diagnostic delay were identified by binary stepwise logistic regression analysis.Results: Among 288 confirmed TB cases, 170 (59.0%) were delayed diagnosis. The median diagnostic delay was 39.5 days. Median patient delay was 23 days and health system delay was 7 days. Income ≤ 315USD/month (OR = 2.97 [95% CI: 1.15– 7.69]), cough (OR = 3.00 [95% CI: 1.16– 7.76]), weight loss (OR = 15.59 [95% CI: 1.85– 131.56]), use of traditional Chinese Medicine (OR = 5.03 [95% CI: 1.04– 24.31]) and over-the-counter cough syrup (OR = 2.73 [95% CI: 1.10– 6.76]) were significant risk factors for patient delay. Fever (OR = 0.13[95% CI: 0.04– 0.48]) and hemoptysis (OR = 0.06 [95% CI0.01– 0.30]) were protective factors for patient delay. Cough (OR = 2.85 [95% CI: 1.49– 5.49]) and availability of chest X-ray (OR = 0.21[CI: 0.11– 0.39]) were factors associated with health system delay.Conclusion: Delayed diagnosis of tuberculosis remains an unresolved problem. Patients with low income, self-treatment with over-the-counter medicine and accepting TCM suffered from a higher risk of patient delay. It is important to give more help to the vulnerable people and strengthen tuberculosis knowledge among primary health providers. Keeping all health providers alert to TB symptoms can facilitate earlier TB diagnosis and better disease control.Keywords: tuberculosis, diagnosis, delay, patient delay, health system delay

Keywords

• tuberculosis
• diagnosis
• delay
• patient delay
• health system delay