A Comparison Of Tuberculosis Incidence In Different Areas And A Study On Tuberculosis Patient Delay

Objective1. To explore the characteristics and overall epidemic level of tuberculosis bycomparing the TB annual incidence in different regions, and to provide a scientificbasis for the health authority to make administrative decisions.2. To investigate the level of TB patient delay and the related risk factors, and toanalyze the factors resulted in patient delay. To provide suggestions for thedevelopment of the related control measures of patient delay.Method1. Guangdong, Hunan and Jiangsu provinces and Shanghai municipality werepurposedly selected as the first sample units to represent areas with more floatingpopulation, central rural areas, eastern rural areas and urban communities in China,respectively. On this basis, the eight secondary study fields were selected using arandom sampling method. The TB-related information was collected through a cohortstudy of the408,889people. The TB annual incidence and incidence density (ID)between different regions and different gender were compared.2. A cluster sampling method was used to extract the study objects from theactive pulmonary TB patuents in the baseline survey and cohort study. The mediantime was used to describe the patient delay level, and accessing the related factors ofpatient delay level by rank-sum test-to analyze the binary variables using theMann-Whitney U test and the multi-categorical variables the Kruskal-Wallis H test.Selecting the delayed patients as the case group and the non-delayed patients as the control. Single-variable and multiple non-conditional logistic regression modelingwere applied for data analysis, and odds ratios (ORs) with their corresponding95%confidence intervals (CIs) were estimated to explore the influencing factors of patientdelay.Results1. In descending order, the active tuberculosis annual incidence was HunanProvince (85.18/100,000), Jiangsu Province (48.39/100,000), Guangdong Province(20.90/100,000) and Shanghai Municipality (13.77/100,000), and37.91/100,000as atotal, and the smear positive TB annual incidence was16.63/100,000.2. Total tuberculosis incidence density was41.13/100,000person–years. TheMale standardized incidence density was63.81/100,000person–years, and18.89/100,000person–years of women. The descending order of the tuberculosisstandardized incidence density of the four study fields was Hunan Province(91.22/100,000person–years), Jiangsu Province (46.21/100,000person–years),Guangdong Province (28.77/100,000person–years) and Shanghai Municipality(14.75/100,000person–years).3. Among the283TB patients of the patient delay study,257(90.81%) were the firstvisit patients. The median day paient delayed was52. The level of the delay for thefirst visits (the median was50days) was lower than the retreats, P=0.031. Theduration of suspicious symptoms also influence the level of the patient delay, and thelevel of one to four weeks duration was the lowest (P=0.001). The delay of the activetuberculosis (median=57days) was longer than the other type of tuberculosis patients(P=0.011).4. The patient delay occurrence in TB patients in this study was88.69%(251/283). We found that there were three factors related to patient delay bymultivariate unconditional logistic regression analysis: the types of suspicioussymptoms (OR=0.28,95%CI:0.11-0.71) and the X-rays with active pulmonarytuberculosis (OR=0.37,95%CI:0.16-0.87) were two protective factors, and the duration of suspicious symptoms was risk factor (OR=4.39,95%CI:1.78-10.84) forpatient delay.Conclusion1. The regional distribution and population distribution of tuberculosis in Chinawere obviously different. The TB incidence density in the central region was higherthan the eastern, and in rural areas was higher than in urban areas; it’s higher infloating population than in household population, higher in men than in women.2. With the high incidence and the long duration of delays, the situation ofpatient delay is serious in China.3. The TB patient delay is closely related to TB suspicious symptoms: in order toreduce patient delay, the department of tuberculosis control should strengthen thesupervision of the TB symptoms, and improve the public awarenesss of tuberculosissymptoms so as to encourage them to go for early detection and treatment.