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2016 — 2021年云南省耐药肺结核患者发现与治疗延迟影响因素分析

Influencing factors of diagnosis and treatment delay among rifampicin-resistant tuberculosis patients in Yunnan province, 2016 – 2021: a registration data analysis

  • 摘要:
    目的  分析2016 — 2021年云南省利福平耐药肺结核患者发现与治疗时间间隔的变化及发生延迟的影响因素,为减少耐药肺结核发现与治疗延迟的发生提供参考依据。
    方法  利用《结核病管理信息系统》中登记报告的云南省2016 — 2021年2189例利福平耐药肺结核患者的病案资料进行不同人口学特征肺结核患者发现时间间隔、治疗时间间隔分布情况。时间间隔以MP25P75) 描述,多因素二元logistic回归分析发现延迟与治疗延迟时间的影响因素。
    结果  共纳入2189例耐药肺结核患者,发现时间间隔中位数变化为先升后降,由2016年的50 d递增至2018年的109 d,后逐年下降至2021年的42 d。检测方法为传统药敏性检测方法(OR = 5.193,95%CI = 3.750~7.193)和首诊医疗机构为州市级(OR = 1.449,95%CI = 1.199~1.752)是耐药肺结核患者发现延迟的影响因素。1488例纳入治疗的耐药患者治疗时间间隔的中位数稍有增长,由2016年的1 d上升至2021年的11 d。男性(OR = 1.309,95%CI = 1.063~1.612)、农民(OR = 1.317,95%CI = 1.022~1.698)、常驻居民(OR = 4.016,95%CI = 3.220~5.008)为耐药肺结核患者治疗延迟的影响因素,与 ≥ 65岁人群比较,25~35岁(OR = 0.676,95%CI = 0.487~0.938)、35~45岁(OR = 0.687,95%CI = 0.494~0.954)、45~55岁(OR = 0.663,95%CI = 0.489~0.901)为耐药肺结核患者治疗延迟的保护因素。
    结论 云南省利福平耐药肺结核患者发现时间间隔大幅缩短,治疗时间间隔较短,且应关注延迟天数较长的危险人群,有效控制耐药结核病疫情发展。

     

    Abstract:
    Objective To analyze the changes in the time intervals between diagnosis and treatment and the influencing factors of diagnosis and treatment delay among rifampicin-resistant tuberculosis (RR-TB) patients from 2016 to 2021 in Yunnan province, to provide a reference for reducing the occurrence of diagnosis and treatment delay in patients.
    Methods Data of 2 189 RR-TB patients registered in Yunnan province from 2016 to 2021 were extracted from the Tuberculosis Management Information System (TMIS) – a subsystem of the China Disease Prevention and Control Information System – to analyze the time intervals between symptom onset and diagnosis and that between diagnosis and treatment for the patients with different demographic and other characteristics. The time intervals were described in median and percentile 25th/75th (M, P25/P75) days, and multivariate binary logistic regression was used to analyze factors influencing delays in diagnosis and treatment of RR-TB patients.
    Results For all patients, the median number of days from symptom onset to confirmed diagnosis of RR-TB increased from 50 in 2016 to 109 in 2018, but then decreased annually to 42 in 2021, with a trend of first increasing and then decreasing. The RR-TB patients who underwent conventional drug susceptibility testing and received initial diagnosis at a prefectural or municipal-level medical institution were more likely to have delayed diagnosis, with the odd ratio (OR) and 95% confidence interval (95%CI) of 5.193 (3.750 – 7.193) and 1.449 (1.199 – 1.752), respectively. The median number of days from diagnosis to treatment for the 1 488 RR-TB patients being treated increased slightly from one day in 2016 to 11 days in 2021. The RR-TB patients with the following characteristics were more likely to have treatment delays: being male (OR = 1.309, 95%CI: 1.063 – 1.612), being a farmer (OR = 1.317, 95%CI: 1.022 – 1.698), and being a permanent resident (OR = 4.016, 95%CI: 3.220 – 5.008) ; whereas RR-TB patients of younger age were less likely to have treatment delay, with the OR (95%CI) of 0.676 (0.487 – 0.938), 0.687 (0.494 – 0.954), and 0.663 (0.489 – 0.901) for the patients aged 25 – 34, 35 – 44, and 45 – 55 years respectively, compared with those aged ≥ 65 years.
    Conclusion During 2016 – 2021, the time interval between symptom onset and diagnosis was significantly shortened and the interval between diagnosis and treatment was relatively short for RR-TB patients in Yunnan province but attention still needs to be paid to patients at high risk of delayed diagnosis and treatment.

     

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