2005—2023年淄博市肺结核患者发现延误及影响因素分析

doi:10.12183/j.scjpm.2025.0709

摘要/Abstract

摘要： 目的分析2005—2023年淄博市肺结核患者发现延误情况及影响因素,为提高患者发现质量提供依据。方法收集中国疾病预防控制信息系统传染病监测系统中2005—2023年淄博市肺结核患者病案相关信息,包括人口基本特征、诊断结果、治疗分类、患者来源、首诊断地区、登记时间,以及本次症状出现日期、首诊日期和确诊日期等。患者发现延误率年度变化趋势采用曲线回归分析,单因素分析比较不同因素的组间差异,多因素logistic回归模型分析肺结核患者发现延误影响因素。结果 2005—2023年淄博市登记的24 792例肺结核患者发现时间间隔中位数为40（20,77）d,主要由就诊时间间隔构成（76.95%）,年均发现延误率65.87%,总体呈先升后降趋势（Cubic回归：R²=0.787,F=18.501,P<0.001）,2020年后逐年下降。多因素logistic回归分析结果显示,45~<65岁年龄组（OR=1.115）、农（牧、渔）民（工）（OR=1.412）、工人（OR=1.299）、无业（离退）人群（含学龄前儿童）（OR=1.581）、追踪来源（OR=2.677）、本区县（OR=1.360）和其他区县（OR=2.208）、初治（OR=1.290）和病原学阳性（OR=1.086）是肺结核患者发现延误的危险因素;年龄<45岁（OR=0.839、0.879）、患者来源为健康体检（OR=0.177）、主动筛查（OR=0.328）、推介（OR=0.632）和转诊（OR=0.757）为患者发现延误的保护因素。结论淄博市肺结核患者发现延误情况普遍且较为严重,就诊延误是主要原因,亟需在全市范围内尤其针对重点人群强化健康教育与主动发现等措施,提高就诊意识,缩短发现时间间隔,降低发现延误。

关键词: 结核, 肺, 就诊延误, 延误诊断, 因素分析

Abstract: Objective To analyze the patterns and determinants of diagnostic delays among pulmonary tuberculosis (PTB) patients in Zibo City from 2005 to 2023, providing evidence for improving case detection efficiency. Methods Data were extracted from the Infectious Disease Surveillance System of China Disease Control and Prevention Information System, encompassing 24, 792 PTB cases registered in Zibo City (2005~2023). Variables included demographic characteristics, diagnostic results, treatment classification, patient source, initial diagnosis location, registration date, and key time intervals (symptom onset, first medical consultation, and confirmed diagnosis). Temporal trends in delay rates were analyzed using curve regression. Univariate comparisons and multivariable logistic regression identified factors associated with diagnostic delays. Results The median total delay interval was 40 (IQR: 20~77) days, predominantly attributable to patient-related delays (76.95%). The annual delay rate averaged 65.87%, exhibiting an initial rise followed by a decline (Cubic regression: R²=0.787, F=18.501, P<0.001), with sustained reductions post-2020. Multivariate logistic regression analysis showed that age 45~<65 years (OR=1.115), farmers/fishermen/migrant workers(OR=1.412), industrial workers (OR=1.299), unemployed/retired individuals (OR=1.581), tracking source (OR=2.677), local county (OR=1.360) and other counties (OR=2.208), initial treatment(OR=1.290) and pathogen positivity (OR=1.086) are risk factors for delayed diagnostic delays.While the protective factors are age <45 years (OR=0.839, 0.879), with sources of health check-up (OR=0.177), active screening (OR=0.328), referrals (OR=0.632), and clinician-initiated transfers (OR=0.757). Conclusions Diagnostic delays among PTB patients in Zibo remain prevalent and severe, primarily driven by prolonged intervals to first medical consultation. Targeted interventions—particularly health education and active case-finding strategies for high-risk populations—are urgently needed to enhance healthcare-seeking behavior and reduce delays.

Key words: Tuberculosis, pulmonary, Patient delay, Delayed diagnosis, Factor analysis

中图分类号:

R195

高风华, 李源, 边文建, 孔祥达. 2005—2023年淄博市肺结核患者发现延误及影响因素分析[J]. 华南预防医学, 2025, 51(7): 709-714.

GAO Fenghua, LI Yuan, BIAN Wenjian, KONG Xiangda. Diagnostic delays and influencing factors among pulmonary tuberculosis patients in Zibo, 2005-2023[J]. South China Journal of Preventive Medicine, 2025, 51(7): 709-714.

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