Risk factors for patient delay in fast-aging and urbanized pulmonary tuberculosis patients over a decade 2023

Globally, tuberculosis (TB) is the primary infectious cause of mortality and morbidity. However, the delay in obtaining health care has remained unacceptable.

This study aimed to determine the trend of patient delay and its associated risk factors during accelerated aging and urbanization in Wuhan, China between 2008 and 2017.

Methods

From January 2008 to December 2017, a total of 63,720 TB patients registered at Wuhan TB Information Management System were included.

Long patient delay (LPD) is defined as a patient delay of 14 days or more. Using logistic regression models, the independent associations of area and household identity with LPD, as well as their interaction effect, were examined.

Results

71.3 percent of the 63,720 pulmonary TB patients were male, with a mean age of 45.5 18.8 years. The median patient delay was 10 days (interquartile range [IQR], 3–28). 41.3% of patients, or 26,360, were delayed for more than 14 days. From 44.8% in 2008 to 38.0% in 2017, the rate of LPD decreased. Except for living space, similar trends were observed across all subgroups by gender, age, and household composition.

The proportion of patients with LPD decreased from 46.3% to 32.8% when they lived close to the city center, but increased from 43.2% to 45.5% when they lived far from the city center. Further interaction effect analysis revealed that, among patients residing far from the city center, the risk of LPD increased with age for local patients but decreased with age for immigrant patients.

Conclusion

Although the aggregate LPD among patients with pulmonary tuberculosis decreased over the past decade, the degree of decline varied between subgroups. In Wuhan, China, the elderly locals and young migrant patients residing far from the city center are the most susceptible to LPD.