湖州市2008-2018年肺结核患者就诊延迟情况及影响因素

傅丽娟; 汪业胜; 朱文龙; 王伟炳

doi:10.16462/j.cnki.zhjbkz.2021.02.022

湖州市2008-2018年肺结核患者就诊延迟情况及影响因素

doi: 10.16462/j.cnki.zhjbkz.2021.02.022

200032 上海，复旦大学公共卫生学院流行病学教研室

基金项目:

国家自然科学基金 81673233

“十三五”国家科技重大专项 2017ZX10201302

“十三五”国家科技重大专项 2018ZX10722302-005

详细信息

通讯作者:
王伟炳，E-mail: wwb@fudan.edu.cn

中图分类号: R181
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出版历程
- 收稿日期: 2020-09-02
- 修回日期: 2020-11-09
- 刊出日期: 2021-02-10

Consultation delay and influencing factors among pulmonary tuberculosis patients in Huzhou City from 2008 to 2018

Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China

Funds:

National Natural Science Foundation of China 81673233

"13th Five-Year Plan" National Science and Technology Major Project 2017ZX10201302

"13th Five-Year Plan" National Science and Technology Major Project 2018ZX10722302-005

More Information

Corresponding author: Wang Wei-bing, E-mail: wwb@fudan.edu.cn

摘要

摘要: 目的了解湖州市2008-2018年肺结核就诊延迟特点、变化趋势，并分析影响因素，为结核防控提供依据。方法从“结核病管理信息系统”中收集2008-2018年湖州市肺结核确诊患者就诊延迟的病案信息，χ²检验用于单因素分析，χ²趋势检验用于率及构成比的时间趋势检验，多因素Logistic回归分析模型用于分析就诊延迟的影响因素。结果 2008-2018年湖州市肺结核患者就诊延迟率为52.9%，总体呈逐年下降趋势(χ²_趋势=149.581, P < 0.001)，不同性别及年龄段下就诊延迟率也呈现相同趋势。就诊延迟患者以男性、≥60岁为主，但女性构成比总体上升(χ²_趋势=10.320, P < 0.001)。多因素Logistic回归分析模型显示，女性、高龄、本地户籍、追踪、因症就诊、痰检阳性和初治的肺结核患者就诊延迟风险更高(均有P < 0.05)。结论 2008-2018年湖州市肺结核就诊延迟患者以男性、≥60岁为主，但女性构成比呈上升趋势。就诊延迟率11年间呈现下降趋势。性别、年龄、户籍、患者来源、痰检结果、治疗分类是其就诊延迟的影响因素。
- 肺结核 /
- 就诊延迟 /
- 影响因素
Abstract: Objective To understand the characteristics, trend and influencing factors of the consultation delay in Huzhou City from 2008 to 2018, so as to provide evidence for tuberculosis (TB) prevention and control. Methods From the Tuberculosis Management Information System (TMIS), we collected the data of the TB consultation delay from 2008 to 2018 in Huzhou City. χ² test was used for single factor analysis, χ² trend test was used for time trend test of rate and composition ratio, multivariate Logistic regression model was used to analyze the influencing factors of the delay. Results From 2008 to 2018 in Huzhou City, the consultation delay rate of TB patients was 52.9%, and the overall trend was decreasing year by year (χ²_trend=149.581, P < 0.001), different gender and age groups also showed the same trend. The delayed patients were mainly male, over 60 years old, but the proportion of female was increasing (χ²_trend=10.320, P < 0.001). Multivariate Logistic regression model showed that women, elderly, local residents, follow-up, see a doctor due to symptoms, sputum positive and newly diagnosed TB patients were associated with a higher risk of consultation delay (all P < 0.05). Conclusions From 2008 to 2018, the majority of TB consultation patients in Huzhou City were males, over 60 years old but the proportion of females showed an upward trend. The delay rate showed a downward trend. Gender, age, registered residence, source of patients, sputum examination results and treatment classification were the factors influencing the consultation delay.
- Pulmonary tuberculosis /
- Consultation delay /
- Influcing factors

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表 1 湖州市2008-2018年肺结核患者就诊延迟人数[率(%)]

Table 1. The number of pulmonary tuberculosis patients consultation delay in Huzhou City from 2008 to 2018 [rate (%)]

年份(年)	合计	性别		年龄(岁)
年份(年)	合计	男	女	< 30	30~	45~	≥60
2008	1 148(60.3)	795(57.7)	353(67.1)	241(49.9)	258(54.1)	238(62.0)	411(73.4)
2009	1 059(53.3)	782(53.2)	277(53.5)	215(45.6)	243(50.2)	227(55.2)	374(60.2)
2010	930(50.7)	672(49.2)	258(54.9)	216(45.5)	201(44.4)	192(50.9)	321(60.6)
2011	925(56.6)	651(55.5)	274(59.4)	226(48.4)	203(52.2)	208(58.8)	288(67.8)
2012	852(55.9)	585(55.1)	267(57.7)	213(49.5)	176(49.4)	183(61.4)	280(63.5)
2013	957(64.7)	666(62.2)	291(71.3)	257(56.2)	174(58.0)	233(72.6)	293(73.1)
2014	828(57.7)	544(56.4)	284(60.3)	204(49.3)	175(57.2)	195(61.9)	254(63.5)
2015	729(54.1)	498(52.1)	231(58.8)	167(48.5)	148(50.9)	164(53.4)	250(61.6)
2016	486(37.6)	339(37.7)	147(37.2)	99(30.7)	92(33.6)	92(33.2)	203(48.2)
2017	490(41.2)	331(40.0)	159(43.9)	102(34.1)	89(37.7)	104(41.8)	195(48.0)
2018	479(41.6)	316(39.9)	163(45.3)	103(37.1)	83(37.7)	97(40.2)	196(47.5)

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表 2 湖州市2008-2018年肺结核患者就诊延迟的影响因素的单因素分析结果[n(%)]

Table 2. Univariate analysis results of influencing factors of consultation delay in pulmonary tuberculosis patients in Huzhou City from 2008 to 2018 [n(%)]

变量	就诊延迟		χ²值	P值
变量	否	是	χ²值	P值
性别			26.014	< 0.001
男	5 778(73.1)	6 179(69.6)
女	2 123(26.9)	2 704(30.4)
年龄(岁)			249.038	< 0.001
≥60	1 959(24.8)	3 065(34.5)
45~	1 601(20.3)	1 933(21.8)
30~	1 944(24.6)	1 842(20.7)
< 30	2 397(30.3)	2 043(23.0)
职业			73.361	< 0.001
农民	3 707(46.9)	4 756(53.5)
非农民	4 194(53.1)	4 127(46.5)
户籍			281.734	< 0.001
非本地户籍	3 442(43.6)	2 757(31.0)
本地户籍	4 459(56.4)	6 126(69.0)
患者来源			578.810	< 0.001
接触者检查	7(0.1)	6(0.1)
转诊	4 837(61.2)	4 038(45.5)
追踪	1 304(16.5)	2 461(27.7)
因症就诊	1 433(18.2)	2 178(24.5)
健康检查	244(3.1)	109(1.2)
其他	66(0.8)	80(0.9)
因症推荐	10(0.1)	11(0.1)
痰检结果			130.526	< 0.001
阳性	1 964(24.9)	2 921(32.9)
阴性	5 937(75.1)	5 962(67.1)

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表 3 湖州市2008-2018年肺结核就诊延迟多因素Logistic回归分析

Table 3. Multivariate Logistic regression analysis on risk factors of consultation delay among pulmonary tuberculosis patients in Huzhou City from 2008 to 2018

变量	β值	s_x	Wald χ²值	OR(95% CI)值	P值
性别
男				1.000
女	0.199	0.036	31.237	1.220(1.138~1.309)	< 0.001
年龄(岁)
< 30				1.000
30~	0.120	0.045	7.006	1.128(1.032~1.233)	0.008
45~	0.262	0.048	29.743	1.300(1.183~1.428)	< 0.001
≥60	0.435	0.047	87.648	1.546(1.411~1.693)	< 0.001
户籍
非本地户籍				1.000
本地户籍	0.342	0.037	86.531	1.408(1.310~1.513)	< 0.001
患者来源
转诊				1.000
追踪	0.739	0.041	323.988	2.095(1.933~2.270)	< 0.001
因症就诊	0.687	0.041	276.187	1.988(1.833~2.155)	< 0.001
健康检查	-0.217	0.120	3.298	0.805(0.636~1.017)	0.069
其他	0.611	0.171	12.768	1.841(1.317~2.574)	< 0.001
因症推荐	0.280	0.441	0.404	1.324(0.558~3.142)	0.525
接触者检查	0.373	0.565	0.437	1.453(0.480~4.396)	0.509
痰检结果
阴性				1.000
阳性	0.334	0.036	87.451	1.397(1.302~1.498)	< 0.001
治疗分类
复治				1.000
初治	0.215	0.049	18.946	1.240(1.125~1.366)	< 0.001

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