2004年黑龙江省结核病患者就诊延迟情况及影响因素分析

doi:10.3969/j.issn.2096-8493.2020.03.013

摘要/Abstract

摘要：

目的了解结核病患者就诊延迟情况及其影响因素。方法于2004年1—12月,采用分层整群抽样方法,在黑龙江省113个结核病防治单位确定30个调查点,每个调查点均需完成56例初治涂阳肺结核患者的调查及在此期间的复治涂阳肺结核患者的调查,最终纳入调查对象1989例。收集调查对象基础信息、临床信息及病案记录信息,分析其就诊延迟情况及影响因素。结果 1989例调查对象中就诊延迟时间[中位数(四分位数)]为35(15,88)d;就诊延迟≤30d者有836例(42.0%),就诊延迟>30d者有1153例(58.0%)。就诊延迟≤30d组中,在业人员占52.0%(435/836),明显高于就诊延迟>30d组的50.2%(579/1153);就诊延迟≤30d组中,首发症状无乏力者占44.2%(369/834),明显低于就诊延迟>30d组的50.1%(577/1151);就诊延迟≤30d组中,首次就诊单位为结核病防治所者占31.6%(100/316),明显高于就诊延迟>30d组的20.6%(58/281);差异均有统计学意义(χ²分别为10.325、6.716、9.551,P值分别为0.006、0.010、0.023)。多因素logistic回归分析显示,与非在业人员相比,在业人员就诊延迟更短[OR(95%CI)=0.600(0.007~0.505)];首发症状为乏力者比无乏力者就诊延迟更长[OR(95%CI)=1.778(1.263~2.503)];与首次就诊单位为综合医院者相比,首诊单位为结核病防治所者就诊延迟更短[OR(95%CI)=0.611(0.396~0.942)]。结论黑龙江省结核病患者就诊延迟现象明显,非在业人员、首发症状为乏力及首诊单位选择综合医院的患者易出现就诊延迟。

关键词: 结核, 延误诊断, 因果律, 横断面研究

Abstract:

Objective To explore tuberculosis patient delay and influencing factors. Methods From January to December, 2004, a stratified cluster sampling method was used to determine 30 survey sites in 113 tuberculosis control units in Heilongjiang Province. In each survey site, the survey of 56 newly treated smear-positive pulmonary tuberculosis patients and retreated smear-positive pulmonary tuberculosis patients during this period should be finished, and finally 1989 cases were included. The basic and clinical information, as well as medical record of the cases were collected to analyze patient delay and influencing factors. Results Among the 1989 cases, the delay time (median (quartile)) was 35 (15, 88) d; 836 cases (42.0%) had a delay of ≤30 d, and 1153 (58.0%) cases had a delay of more than 30 d. In the group with a delay of ≤30 d, proportions of the employed and cases who chose tuberculosis prevention and treatment unit for the first visit were significantly higher than that in the group with a delay of more than 30 d (52.0% (435/836) vs. 50.2% (579/1153, χ²=10.325, P=0.006) (31.6% (100/316) vs. 20.6% (58/281), χ²=9.551, P=0.023). However, proportion of patients whose first symptom was fatigue in the group with a delay of ≤30 d was significantly lower than that in the group with a delay of more than 30 days (44.2% (369/834) vs. 50.1% (577/1151), χ²=6.716, P=0.010). Multivariate logistic regression analysis showed that compared with non-employed persons, the patient delay of the employed was shorter (OR (95%CI)=0.600 (0.007-0.505)); those who with fatigue as the first symptom had more delay than those who without fatigue (OR (95%CI)=1.778 (1.263-2.503)); compared to those who chose a general hospital for the first visit, cases who chose a tuberculosis prevention and treatment center for the first visit was had shorter visit delay (OR (95%CI)=0.611 (0.396-0.942)). Conclusion The patient delay of tuberculosis patients in Heilongjiang was obvious. It was more likely to happen ine non-employed, patients whose first symptom was fatigue, and patients who chose general hospitals for the first visit.

Key words: Tuberculosis, Delayed diagnosis, Causality, Cross-sectional studies

孙明雷, 吴群红, 关黎, 赵娟, 王晨, 邹丹丹, 梁立波. 2004年黑龙江省结核病患者就诊延迟情况及影响因素分析[J]. 结核与肺部疾病杂志, 2020, 1(3): 270-275. doi: 10.3969/j.issn.2096-8493.2020.03.013

SUN Ming-lei, WU Qun-hong, GUAN Li, ZHAO Juan, WANG Chen, ZOU Dan-dan, LIANG Li-bo. Analysis of situation and influencing factors of patient delay in tuberculosis in tuberculosis patients from Heilongjiang in 2004[J]. Journal of Tuberculosis and Lung Disease, 2020, 1(3): 270-275. doi: 10.3969/j.issn.2096-8493.2020.03.013

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特征	就诊延迟≤30d(836例)		就诊延迟>30d(1153例)		合计(1989例)		χ²值	P值
特征	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	χ²值	P值
性别							0.112	0.738
男	583	69.7	796	69.0	1379	69.3
女	253	30.3	357	31.0	610	30.7
年龄组(岁)							23.930	0.000
0~	282	33.7	296	25.7	578	29.1
35~	228	27.3	289	25.1	517	26.0
45~	158	18.9	257	22.2	415	20.9
55~92	168	20.1	311	27.0	479	24.0
居住地							4.788	0.188
城市	211	25.2	245	21.2	456	22.9
城镇	161	19.3	247	21.4	408	20.5
农村	446	53.3	634	55.0	1080	54.3
牧、林、矿区	18	2.2	27	2.4	45	2.3
职业							10.325	0.006
学生	59	7.1	48	4.2	107	5.4
在业	435	52.0	579	50.2	1014	51.0
非在业	342	40.9	526	45.6	868	43.6

临床特征	就诊延迟≤30d(836例)		就诊延迟>30d(1153例)		合计(1989例)		χ²值	P值
临床特征	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	χ²值	P值
首发症状
咳嗽^a							8.946	0.003
是	68	8.1	56	4.9	124	6.2
否	767	91.9	1097	95.1	1864	93.8
咯血^a							7.350	0.007
是	739	88.5	1061	92.1	1800	90.6
否	96	11.5	91	7.9	187	9.4
胸痛^a							1.136	0.287
是	573	68.8	818	71.0	1391	70.1
否	260	31.2	334	29.0	594	29.9
发热^a							7.025	0.008
是	441	52.9	678	58.9	1119	56.3
否	393	47.1	474	41.1	867	43.7
乏力^a							6.716	0.010
是	465	55.8	574	49.9	1039	52.3
否	369	44.2	577	50.1	946	47.7
食欲不振^a							0.259	0.611
是	738	88.5	1009	87.7	1747	88.1
否	96	11.5	141	12.3	237	11.9
盗汗^a							0.005	0.945
是	629	75.7	872	75.8	1501	75.8
否	202	24.3	278	24.2	480	24.2
临床特征	就诊延迟≤30d(836例)		就诊延迟>30d(1153例)		合计(1989例)		χ²值	P值
临床特征	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	χ²值	P值
耐药类型							4.242	0.237
敏感	471	56.3	669	58.0	1140	57.3
单耐药	186	22.2	252	21.9	438	22.0
耐多药	113	13.5	125	10.8	238	12.0
多耐药	66	8.0	107	9.3	173	8.7
治疗情况							42.184	0.000
复治	233	27.9	183	15.9	416	20.9
初治	603	72.1	970	84.1	1573	79.1
首次就诊单位^a							9.551	0.023
综合医院	120	38.0	126	44.8	246	41.2
结核病防治所	100	31.6	58	20.6	158	26.5
专科医院	50	15.8	47	16.7	97	16.2
诊所或自服药物	46	14.6	50	17.9	96	16.1

因素	赋值	因素	赋值
就诊延迟	≤30d=0;>30d=1	首发症状	否=0;是=1
年龄组	0~岁=0;35~岁=1;45~岁=2;55~92岁=3	治疗情况	初治=0;复治=1
职业	非在业=0;在业=1;学生=2	首次就诊单位	综合医院=0;诊所或自服药物=1;结核病防治所=2;专科医院=3

变量	β值	$s_{\bar{x}}$值	Wald χ²值	P值	OR(95%CI)值
年龄组(以“0~岁组”为参照)
35~岁	0.153	0.265	0.333	0.564	0.858(0.510~1.443)
45~岁	0.127	0.264	0.230	0.631	1.135(0.676~1.905)
55~92岁	0.066	0.271	0.060	0.807	1.068(0.629~1.816)
职业(以“非在业组”为参照)
在业	2.817	1.089	6.689	0.010	0.600(0.007~0.505)
学生	0.331	0.175	3.566	0.059	0.718(0.509~1.013)
首发症状
咳嗽	0.064	0.387	0.028	0.868	1.066(0.499~2.278)
咯血	0.454	0.263	2.988	0.084	0.635(0.380~1.063)
发热	0.259	0.177	2.129	0.145	0.772(0.545~1.093)
乏力	0.576	0.174	10.887	0.001	1.778(1.263~2.503)
治疗情况(以“初治组”为参照)
复治	0.354	0.199	3.180	0.075	0.702(0.475~1.036)
首次就诊单位(以“综合医院组”为参照)
诊所或自服药物	0.083	0.250	0.109	0.742	1.086(0.665~1.774)
结核病防治所	0.493	0.221	4.976	0.026	0.611(0.396~0.942)
专科医院	0.037	0.255	0.021	0.884	1.038(0.629~1.712)