Factors influencing the delay of seeking medical treatment among students with tuberculosis in Shaanxi Province from 2015 to 2019
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摘要:
目的 分析2015—2019年陕西省学生肺结核患者就诊延迟情况及影响因素，为学校防控结核病疫情工作提供科学依据。 方法 通过《中国疾病预防控制信息系统》的子系统《结核病管理信息系统》，收集2015—2019年陕西省登记的6 739例学生肺结核患者信息，采用单因素分析和多因素Logistic回归分析方法，分析学生肺结核患者就诊延迟特征及影响因素。 结果 6 739例学生肺结核患者中，就诊延迟患者共计3 040名，就诊延迟率高达45.1%，就诊延迟时间中位数为38(24~68)d。2015—2019年学生患者就诊延迟率总体呈下降趋势，不同年份差异有统计学意义(χ2=120.45，P < 0.05)。单因素分析显示，不同患者来源、诊断结果、区域学生的就诊延迟率差异均有统计学意义(χ2值分别为274.19，26.75，24.12，P值均 < 0.05)，追踪、结核病胸膜炎、陕北地区就诊延迟率更高。多因素Logistic回归分析结果显示，区域为陕北(OR=2.74)、关中(OR=2.09)、陕南(OR=2.39)和患者来源为因症就诊(OR=1.84)、因症推荐(OR=2.81)、转诊(OR=3.28)、追踪(OR=6.07)与就诊延迟呈正相关，诊断结果为无病原学结果(OR=0.47)与就诊延迟呈负相关(P值均 < 0.05)。 结论 陕西省2015—2019年学生肺结核患者就诊延迟现象较为普遍，区域、患者来源、诊断结果是学生肺结核患者就诊延误的影响因素，应采取综合措施减少学生就诊延迟。 Abstract:Objective To analyze the delay of seeking medical treatment and associated factors among students with tuberculosis in Shaanxi Province from 2015 to 2019, so as to provide scientific evidence for the early detection and control of tuberculosis epidemics in schools. Methods Data from 6 739 students with pulmonary tuberculosis registered in Shaanxi Province from 2015 to 2019 were collected from the TB Management Information System of China Information System for Disease Control and Prevention. Univariate and multivariate Logistic regression analyses were used to analyze the characteristics and influencing factors of pulmonary tuberculosis patients. Results Among 6 739 cases of students with pulmonary tuberculosis from 2015 to 2019 in Shaanxi Province, 3 040 patients delayed seeking medical treatment. The rate of delayed treatment was as high as 45.1%, and the median delayed treatment time was 38(24, 68) days. From 2015 to 2019, the overall delay rate of students showed a downward trend, with a significant difference(χ2=120.45, P < 0.05). Univariate analysis showed that there were statistically significant differences in delay rate between different patient sources, diagnosis results and regions(χ2=274.19, 26.75, 24.12, P < 0.05), among which for factors such as tracing, tuberculosis pleurisy, doctor delay in the northern part of Shaanxi, the rates were higher. The results of multivariate Logistic regression analysis showed that the regions of northern Shaanxi(OR=2.74), central Shaanxi(OR=2.09), and southern Shaanxi(OR=2.39), and clinical consultation(OR=1.84), recommendation(OR=2.81), tracing(OR=3.28), and tracing (OR=6.07) were risk factors for delay of consultation. A lack of etiology results(OR=0.47) was to protect delay of consultation. Conclusion From 2015 to 2019 in Shaanxi Province, a delay in seeking medical treatment was relatively common among students with tuberculosis. The region, source of patients and diagnosis results were factors that influenced the delay in finding tuberculosis patients in Shaanxi Province. -
Key words:
- Tuberculosis, pulmonary /
- Diagnosis /
- Time /
- Regression analysis /
- Students
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表 1 不同组别就诊延迟学生肺结核患者就诊延迟天数比较[M(P25，P75), d]
Table 1. Comparison of delay days of tuberculosis patients in different groups[M(P25, P75), d]
组别 就诊延迟人数 就诊延迟天数 Z值 P值 性别 男 1 931 38(23，68) -1.05 0.29 女 1 109 38(5，67) 学校类型 幼儿园 2 25.5(20，29) 13.17 0.00 小学 96 45.5(26，77) 中学 1 348 36(23，63) 大学 1 594 39(25，71) 户籍 本地 1 792 35(22，63) -5.69 0.00 流动 1 248 42(27，75) 患者来源 健康检查 50 24.5(17，52) 72.23 0.00 接触者检查 7 28(17，52) 因症就诊 582 31(20，59) 转诊 1 781 28(18，88) 追踪 616 38(25，65) 其他 4 47(30，80) 诊断结果 病原学检查阳性 764 39(24，67) 36.04 0.00 病原学检查阴性 1 895 39(25，70) 结核性胸膜炎 325 30(19，50) 无病原学结果 56 35.5(27，67) 重症 否 3 021 38(24，67) -0.85 0.40 是 19 59(28，92) 治疗分类 初治 3 015 38(24，68) -0.26 0.80 复治 25 40(27，63) 区域 外省 18 41(26，81) 20.39 0.00 陕北 808 39(26，72) 关中 1 616 39(24，69) 陕南 598 32(22，60) 
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表 2 陕西省2015—2019年学生肺结核患者就诊延迟影响因素单因素分析
Table 2. Univariate regression analysis of the patients delay of students' tuberculosis and its influencing factors in Shaanxi Province from 2015 to 2019
因素 人数 就诊延迟人数 χ2值 P值 性别 男 4 310 1 931(44.8) 0.46 0.50 女 2 429 1 109(45.7) 学校类型 幼儿园 4 2(50.0) 7.11 0.07 小学 186 96(51.6) 中学 3 088 1 348(43.7) 大学 3 461 1 594(46.1) 户籍 本地 4 000 1 792(44.8) 0.38 0.54 流动 2 739 1 248(45.6) 患者来源 健康检查 229 50(21.8) 274.19 < 0.01 接触者检查 40 7(17.5) 因症就诊 1 698 582(34.3) 转诊 3 773 1 781(47.2) 追踪 984 616(62.6) 其他 15 4(26.7) 诊断结果 病原学检查阳性 1 712 764(44.6) 26.75 < 0.01 病原学检查阴性 4 204 1 895(45.1) 结核性胸膜炎 636 325(51.1) 无病原学结果 187 56(29.9) 重症 否 6 692 3 021(45.1) 0.42 0.52 是 47 19(40.4) 治疗分类 初治 6 676 3 015(45.2) 0.76 0.38 复治 63 25(39.7) 区域 外省 78 18(23.1) 24.12 < 0.01 陕北 1 667 808(48.5) 关中 3 642 1 616(44.4) 陕南 1 352 598(44.2) 注：()内数字为就诊延迟率/%。
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表 3 陕西省2015—2019年学生肺结核患者就诊延迟多因素Logistic回归分析(n=6 739)
Table 3. Multivariate Logistic regression analysis of the patients delay of students' tuberculosis and its influencing factors in Shaanxi Province from 2015 to 2019(n=6 739)
自变量 β值 标准误 Wald χ2值 P值 OR值(OR值95%CI) 性别 男 1.00 女 0.07 0.05 1.93 0.17 1.08(0.97~1.19) 户籍 本地 1.00 流动 -0.05 0.05 1.01 0.32 0.95(0.85~1.05) 区域 外省 1.00 陕北 1.01 0.28 12.78 0.00 2.74(1.58~4.75) 关中 0.74 0.28 7.00 0.01 2.09(1.21~3.60) 陕南 0.87 0.28 9.44 0.00 2.39(1.37~4.15) 学校类型 幼儿园 1.00 小学 -0.25 1.03 0.06 0.81 0.78(0.10~5.86) 中学 -0.48 1.02 0.23 0.64 0.62(0.08~4.54) 大学 -0.39 1.02 0.15 0.70 0.68(0.09~4.99) 患者来源 健康检查 1.00 接触者检查 -0.21 0.45 0.22 0.64 0.81(0.34~1.95) 因症就诊 0.61 0.17 12.76 0.00 1.84(1.32~2.57) 转诊 1.19 0.17 50.70 0.00 3.28(2.37~4.55) 追踪 1.80 0.18 103.74 0.00 6.07(4.29~8.59) 其他 0.53 0.62 0.73 0.39 1.69(0.50~5.68) 诊断结果 病原学检查阳性 1.00 病原学检查阴性 -0.09 0.06 2.15 0.14 0.92(0.81~1.03) 结核性胸膜炎 0.04 0.10 0.16 0.69 1.04(0.86~1.26) 无病原学结果 -0.75 0.18 18.03 0.00 0.47(0.33~0.67) 重症 否 1.00 是 -0.21 0.31 0.44 0.51 0.81(0.44~1.49) 治疗分类 初治 1.00 复治 -0.09 0.27 0.10 0.75 0.92(0.54~1.56)
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