【摘要】 目的 分析上海市闵行区肺结核就诊延误、诊断延误和发现延误的影响因素，为有效减少肺结核病例延误提供依据。方法 通过中国疾病预防控制信息系统传染病报告信息管理系统收集2017—2022年闵行区肺结核病例资料，描述性分析肺结核就诊延误率、诊断延误率和发现延误率；采用多因素logistic回归模型分析肺结核就诊延误、诊断延误和发现延误的影响因素。结果 2017—2022年闵行区报告肺结核病例4 214例，男性2 802例，女性1 412例，男女比为1.98∶1。年龄以25～<45岁为主，1 664例占39.49%。肺结核就诊延误率为36.81%，诊断延误率为30.21%，发现延误率为38.09%。多因素logistic回归分析结果显示，肺结核就诊延误与年份（2018年，OR=0.708;2019年，OR=0.549;2020年，OR=0.670;2021年，OR=0.682）、性别（女，OR=1.199）、职业（工人，OR=1.379；家政/家务/待业，OR=1.481）、病例发现方式（因症就诊，OR=11.159）和首诊医院级别（市级，OR=1.528）有关；诊断延误与年龄（45～<65岁，OR=1.476）、职业（商业服务人员，OR=0.687；家政/家务/待业，OR=0.672）、户籍（非本地，OR=0.820）、病例发现方式（因症就诊，OR=0.616）、病原学结果 （阴性/未查，OR=1.903）和首诊医院级别（市级，OR=0.311）有关；发现延误与年份（2018年，OR=0.785;2019年，OR=0.647;2020年，OR=0.790;2021年，OR=0.710）、职业（商业服务人员，OR=0.687）、户籍（非本地，OR=0.848）和首诊医院级别（市级，OR=0.560）有关。结论 年份、性别、职业、病例发现方式和首诊医院级别是闵行区肺结核就诊延误的影响因素；年龄、职业、户籍、病例发现方式、病原学结果和首诊医院级别是诊断延误的影响因素；年份、职业、户籍和首诊医院级别是发现延误的影响因素。更多还原

【Abstract】 Objective To investigate the influencing factors for delay in healthcare-seeking, definitive diagnosis and identification in patients with pulmonary tuberculosis(PTB) in Minhang District, Shanghai Municipality, so as to provide the basis for effectively reducing delay in PTB patients. Methods Data of PTB patients in Minhang District from 2017 to 2022 were collected from the Infectious Disease Reporting Information System of Chinese Disease Prevention and Control Information System. The prevalence rates of delay in healthcare-seeking, definitive diagnosis and identification were analyzed, and factors affecting delay in healthcare-seeking, definitive diagnosis and identification were identified using multivariable logistic regression models. Results A total of 4 214 PTB patients were reported in Minhang District from 2017 to 2022, including 2 802 males and 1 412 females, with a male-to-female ratio of 1.98∶1.The majority of patients were aged 25 to <45 years(1 664 cases, 39.49%). The prevalence rates of delay in healthcare-seeking, definitive diagnosis and identification were 36.81%, 30.21% and 38.09%, respectively. Delay in healthcare-seeking was associated with the year(2018, OR=0.708; 2019, OR=0.549; 2020, OR=0.670; 2021, OR=0.682), gender(female, OR=1.199), occupation(worker, OR=1.379; housekeeping service/housework/unemployed, OR=1.481), case identification route(symptom-based consultation, OR=11.159), and level of the first-diagnosed hospital(city-level, OR=1.528). Delay in definitive diagnosis was associated with age(45 to <65 years, OR=1.476), occupation(commercial service, OR=0.687; housekeeping service/housework/unemployed, OR=0.672), household registration(non-local, OR=0.820),case identification route(symptom-based consultation, OR=0.616), pathogen test result(negative/not tested, OR=1.903),and the level of the first-diagnosed hospital(city-level, OR=0.311). Delay in identification was associated with the year(2018, OR=0.785; 2019, OR=0.647; 2020, OR=0.790; 2021, OR=0.710), occupation(commercial service, OR=0.687), household registration(non-local, OR=0.848) and level of the first-diagnosed hospital(city-level, OR=0.560).Conclusions Year, gender, occupation, case identification route and level of the first-diagnosed hospital are influencing factors for delay in healthcare-seeking in PTB patients. Age, occupation, household registration, case identification route, pathogen test result and level of the first-diagnosed hospital are influencing factors for delay in definitive diagnosis. Year, occupation, household registration and level of the first-diagnosed hospital are influencing factors for delay in identification.更多还原