贵阳市2014—2020年学生肺结核患者发现就诊及确诊延迟影响因素分析

白璐璐; 陈洪; 黄延; 张彬兵; 田永琴

doi:10.16835/j.cnki.1000-9817.2021.12.005

贵阳市2014—2020年学生肺结核患者发现就诊及确诊延迟影响因素分析

doi: 10.16835/j.cnki.1000-9817.2021.12.005

贵州省贵阳市疾病预防控制中心结核病防治科，550000

详细信息

作者简介:
白璐璐(1992-)，女，贵州遵义人，硕士，主治医师，主要从事结核病防控工作

通讯作者:
陈洪，E-mail：994175146@qq.com

中图分类号: R521 G478
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-21
- 修回日期: 2021-08-30
- 网络出版日期: 2021-12-23
- 刊出日期: 2021-12-25

Determinants of the delay in case-finding, treatment, and diagnosis among students tuberculosis patients in Guiyang from 2014 to 2020

Department of Tuberculosis Prevention and Control, Guiyang Center for Disease Control and Prevention, Guiyang (550000), China

摘要

摘要: 目的对2014—2020年贵阳市学生肺结核患者发现、就诊及确诊延迟影响因素进行分析，为贵阳市学生肺结核防控工作提供参考依据。方法通过《结核病管理信息系统》收集2014—2020年贵阳市学生肺结核患者病案信息，分析学生肺结核患者发现、就诊、确诊延迟的基本情况及变化趋势，采用χ²检验及多因素Logistic回归模型分析3类延迟的影响因素。结果 2014—2020年贵阳市学生肺结核患者发现、就诊延迟率总体呈上升趋势(χ_趋势²值分别为20.70，31.03，P值均 < 0.05)。2014—2020年贵阳市共报告1 323例有效病例，发现天数中位数为16 d，发现延迟率为48.75%;就诊天数中位数是11 d，就诊延迟率为43.46%;确诊天数中位数为0 d，确诊延迟率为11.87%。多因素Logistic回归模型分析显示，流动人口与发现延迟呈正相关(OR=1.45)，患者来源分类为其他(OR=0.19)、首诊单位级别是县级(OR=0.44)、首诊单位类型为综合医院(OR=0.58)与学生肺结核发现延迟均呈负相关(P值均 < 0.05)。女生(OR=1.32)、流动人口(OR=1.38)与就诊延迟均呈正相关(P值均 < 0.01)。流动人口(OR=1.51)、非重症(OR=5.99)、近城区(OR=2.76)、远城区(OR=4.30)与发生确诊延迟均呈正相关(P值均 < 0.05)，女生(OR=0.65)、少数民族(OR=0.38)、学段为大中专(OR=0.53)、首诊单位类型为专科医院(OR=0.22)与确诊延迟发生均呈负相关(P值均 < 0.05)。结论贵阳市学生肺结核发现、就诊延迟的情况较为普遍。应针对性制定防控措施，降低学生延迟发生率，减少学校结核聚集性疫情的发生风险。
- 结核，肺 /
- 诊断 /
- 回归分析 /
- 学生
Abstract: Objective To analyze factors affecting the delay in the case-finding, treatment and diagnosis of tuberculosis among students during 2014-2020, and to provide a reference for the prevention and control measures of tuberculosis among students in Guiyang City. Methods The medical cases of students with tuberculosis from 2014 to 2020 recorded by "China Disease Prevention and Control Information System" were collected and trend of delays in the detection, treatment, and diagnosis of students with tuberculosis were analyzed, and χ² test and multivariate Logistic regression were used to analyze influencing factors. Results From 2014 to 2020, the rate of delay in the case-finding, treatment, and diagnosis of tuberculosis among students in Guiyang showed a relatively stable trend. From 2014 to 2020, Guiyang City reported a total of 1 323 valid cases, the median number of case-finding was 16 days, and 48.75% of student TB patients were delayed; the median number of treatment was 11 days, the delay rate of treatment was 43.46%; the median number of diagnosis was 0 day, the diagnosis delay rate was 11.87%. The results of multivariate Logistic regression analysis showed that the floating population was a risk factor for delay in case-finding (OR=1.45), the classification of the source of patients as "other" (OR=0.19), the level of the first diagnosed unit was county (OR=0.44), and the type of the first diagnosed unit was general hospital (OR=0.58) were the protective factors for the delayed case-finding of tuberculosis in students(P < 0.05). Female (OR=1.32) and floating population (OR=1.38) were risk factors for delayed treatment. Floating population (OR=1.51), rural areas (OR=4.30), urban fringe (OR=2.76), non-severe patients (OR=5.99) were risk factors for delayed diagnosis, females (OR=0.65), ethnic minorities (OR=0.38), college degree (OR=0.53), and the first diagnosis unit wae a specialist hospital (OR=0.22) were protective factors for delayed diagnosis of tuberculosis in students (P < 0.05). Conclusion The rates of tuberculosis case-finding and treatment delay among students are common, which warrants targeted prevention and control measures to reduce the incidence of student delays and reduce the risk of tuberculosis cluster epidemics in schools.
- Tuberculosis, pulmonary /
- Diagnosis /
- Regression analysis /
- Students

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表 1 贵阳市2014—2020年学生肺结核患者发现、就诊、确诊延迟影响因素的单因素分析

Table 1. Single factor analysis of influencing factors for the case-finding, treatment and diagnosis of tuberculosis among students in Guiyang from 2014 to 2020

因素	项目	人数	发现延迟			就诊延迟			确诊延迟
因素	项目	人数	检出人数	χ²值	P值	检出人数	χ²值	P值	检出人数	χ²值	P值
性别	男	642	297(46.26)	3.10	0.08	256(39.88)	6.53	0.01	91(14.17)	6.35	0.01
	女	681	348(51.10)			319(46.84)			66(9.69)
民族	汉族	1 079	525(48.66)	0.02	0.89	459(42.54)	2.03	0.17	141(13.07)	8.06	0.01
	少数民族	244	120(49.18)			116(47.54)			16(6.56)
学段	小学	59	31(52.54)	9.68	0.02	27(45.76)	5.12	0.16	7(11.86)	15.25	< 0.01
	初中	199	103(51.76)			96(48.24)			18(9.05)
	高中	436	186(42.66)			172(39.45)			35(8.03)
	大中专	629	325(51.67)			280(44.52)			97(15.42)
户籍类型	本地	790	354(44.81)	12.20	< 0.01	319(40.38)	7.58	0.01	76(9.62)	9.46	< 0.01
	外地	533	291(54.60)			256(48.03)			81(15.20)
户籍地	主城区	353	173(49.01)			149(42.21)			49(13.88)
	近城区	373	199(53.35)	5.35	0.07	170(45.58)	0.99	0.61	75(20.11)	48.53	< 0.01
	远城区	597	273(45.73)			256(42.88)			33(5.53)
诊断结果	病原学阳性	388	206(53.09)	6.32	0.04	184(47.42)	7.20	0.03	43(11.08)	0.82	0.67
	病原学阴性	918	428(46.62)			380(41.39)			111(12.09)
	无病原学结果	17	11(64.71)			11(64.71)			3(17.65)
治疗分类	初治	1 295	627(48.42)	2.76	0.07	557(43.01)	5.05	0.03	156(12.05)	1.88	0.17
	复治	28	18(64.29)			18(64.29)			1(3.57)
患者来源	转诊及追踪	929	491(52.85)	37.16	< 0.01	438(47.15)	33.86	< 0.01	129(13.89)	13.92	0.01
	因症就诊	301	130(43.19)			118(39.20)			23(7.64)
	因症推荐	10	5(50.00)			5(50.00)			0
	健康检查	69	12(17.39)			9(13.04)			3(4.35)
	其他	14	7(50.00)			5(35.71)			2(14.29)
首诊医院级别	县级	1 251	598(47.80)	8.33	< 0.01	526(42.05)	18.74	< 0.01	155(12.39)	6.02	0.01
	乡级	72	47(65.28)			49(68.06)			2(2.78)
首诊单位类型	疾病预防控制中心	193	94(48.70)	9.87	0.02	79(40.93)	26.31	< 0.01	36(18.65)	16.61	< 0.01
	乡镇医院	72	47(65.28)			49(68.06)			2(2.78)
	专科医院	118	50(42.37)			36(30.51)			18(15.25)
	综合医院	940	454(48.30)			411(43.72)			101(10.74)
是否重症	是	95	47(49.47)	0.02	0.88	49(51.58)	2.74	0.10	2(2.11)	9.33	< 0.01
	否	1 228	598(48.70)			526(42.83)			155(12.62)
注： ()内数字为检出率/%。

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表 2 贵阳市2014—2020年学生肺结核患者发现、就诊、确诊延迟影响因素的多因素Logistic回归分析(n=1 323)

Table 2. Multivariate Logistic regression analysis of factors affecting the case-finding, treatment and diagnosis of tuberculosis among students in Guiyang City from 2014 to 2020(n=1 323)

因变量	自变量	选项	β值	标准误	Wald χ²值	P值	OR值(OR值95%CI)
发现延迟	学段	初中	0.07	0.28	0.06	0.80	1.07(0.62~1.87)
		高中	0.05	1.71	0.10	0.75	1.06(0.76~1.48)
		大中专	-0.29	0.13	5.00	0.25	0.75(0.58~0.96)
	户籍类型	流动人口	0.37	0.12	9.49	< 0.01	1.45(1.15~1.90)
	诊断结果	病原学阳性	-0.64	0.52	1.55	0.21	0.53(0.19~1.44)
		无病原学结果	-0.43	0.52	0.67	0.41	0.65(0.24~1.81)
	患者来源	因症就诊	0.17	0.55	0.10	0.75	1.18(0.41~3.45)
		因症推荐	-0.22	0.55	0.16	0.69	0.80(0.27~2.38)
		健康检查	-0.73	0.88	0.68	0.41	0.48(0.09~2.70)
		其他	-1.67	0.64	6.84	0.01	0.19(0.05~0.66)
	首诊单位级别	县级	-0.82	0.30	7.65	0.01	0.44(0.25~0.79)
	首诊单位类型	乡级医院	-0.12	0.16	0.54	0.46	0.89(0.65~1.22)
		综合医院	-0.55	0.21	6.97	0.01	0.58(0.38~0.87)
就诊延迟	性别	女	0.28	0.12	5.90	0.02	1.32(1.06~1.66)
	户籍类型	流动人口	0.32	0.12	6.97	0.01	1.38(1.09~1.76)
	诊断结果	病原学阳性	-0.89	0.52	2.99	0.08	0.41(0.15~1.13)
		无病原学结果	-0.72	0.52	1.88	0.17	0.49(0.18~1.36)
	治疗分类	复治	0.69	0.41	2.80	0.95	2.00(0.89~4.49)
	患者来源	因症就诊	0.57	0.57	0.98	0.32	1.76(0.57~5.42)
		因症推荐	0.23	0.58	0.16	0.69	1.26(0.40~3.95)
		健康检查	-0.46	0.90	0.26	0.61	0.63(0.11~3.67)
		其他	-1.57	0.69	5.16	0.02	0.21(0.05~0.81)
	首诊单位级别	县级	0.10	0.06	3.11	0.08	1.10(0.99~1.23)
	首诊单位类型	乡级医院	-0.24	0.16	2.19	0.14	0.79(0.57~1.08)
		专科医院	1.22	0.31	15.32	< 0.01	3.40(1.84~6.27)
		综合医院	-0.87	0.22	15.49	< 0.01	0.42(0.27~0.65)
确诊延迟	性别	女	-0.43	0.18	5.73	0.02	0.65(0.46~0.93)
(n=157)	民族	少数民族	-0.96	0.28	11.44	< 0.01	0.38(0.22~0.67)
	学段	中学	-0.23	0.43	0.28	0.60	0.80(0.34~1.85)
		高中	-0.50	0.28	3.13	0.08	0.61(0.35~1.06)
		大中专	-0.63	0.22	8.20	< 0.01	0.53(0.35~0.82)
	户籍类型	流动人口	0.41	0.19	4.70	0.03	1.51(1.04~2.18)
	户籍地	近城区	1.01	0.24	18.41	< 0.01	2.76(1.73~4.38)
		远城区	1.46	0.22	43.65	< 0.01	4.30(2.79~6.63)
	患者来源	因症就诊	-1.23	1.04	1.41	0.24	0.29(0.04~2.23)
		因症推荐	-0.05	0.18	0.10	0.76	0.95(0.67~1.34)
		健康检查	-0.97	0.61	2.58	0.11	0.38(0.12~1.24)
		其他	0.12	0.78	0.02	0.88	1.13(0.24~5.22)
	首诊单位级别	县级	-1.26	1.03	1.49	0.22	0.28(0.04~2.15)
	首诊单位类型	乡级医院	0.37	0.22	2.71	0.10	1.44(0.93~2.22)
		专科医院	-1.50	0.74	4.11	0.04	0.22(0.05~0.95)
		综合医院	-0.13	0.30	0.19	0.66	0.88(0.49~1.58)
	是否重症	否	1.79	0.73	6.09	0.01	5.99(1.45~24.85)
注：变量性别以男生为参照，民族以汉族为参照; 学段以小学为参照; 诊断结果以病原学阴性为参照; 户籍类型以本地人口为参照; 户籍地以主城区为参照; 患者来源以转诊及追踪为参照; 治疗分类以初治为参照; 首诊断单位级别以乡级为参照; 首诊断单位类型以疾病预防控制中心为参照; 是否重症以是为参照。

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