Association between diagnostic delay and prognosis of pulmonary tuberculosis in Shandong, China: a retrospective study

Background Tuberculosis (TB) is one of the main infectious diseases that seriously threatens global health, while diagnostic delay (DD) and treatment dramatically threaten TB control. Methods Between 2005 and 2017 in Shandong, China, we enrolled pulmonary tuberculosis (PTB) patients with DD. DD tren...

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Published in:BMC pulmonary medicine 2022-08, Vol.22 (1), p.1-309, Article 309
Main Authors: Zhu, Xue-han, Tao, Ning-ning, Zhang, Qian-yun, Song, Wan-mei, An, Qi-qi, Liu, Si-qi, Li, Yi-fan, Long, Fei, Li, Huai-chen
Format: Article
Language:English
Subjects:
Analysis
Care and treatment
Coronaviruses
COVID-19
Diagnosis
Diagnostic delay
Infectious diseases
Mortality
Patients
Poor prognosis
Prognosis
Public health
Pulmonary tuberculosis
Pulmonology
Risk factors
Risk groups
Sputum
Treatment outcome
Trend
Trends
Tuberculosis
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Summary:Background Tuberculosis (TB) is one of the main infectious diseases that seriously threatens global health, while diagnostic delay (DD) and treatment dramatically threaten TB control. Methods Between 2005 and 2017 in Shandong, China, we enrolled pulmonary tuberculosis (PTB) patients with DD. DD trends were evaluated by Joinpoint regression, and associations between PTB patient characteristics and DD were estimated by univariate and multivariate logistic regression. The influence of DD duration on prognosis and sputum smear results were assessed by Spearman correlation coefficients. Results We identified 208,822 PTB cases with a median DD of 33 days (interquartile range (IQR) 18-63). The trend of PTB with DD declined significantly between 2009 and 2017 (annual percent change (APC): - 4.0%, P = 0.047, 2009-2013; APC: - 6.6%, P = 0.001, 2013-2017). Patients aged > 45 years old (adjusted odds ratio (aOR): 1.223, 95% confidence interval (CI) 1.189-1.257, 46-65 years; aOR: 1.306, 95% CI 1.267-1.346, > 65 years), farmers (aOR: 1.520, 95% CI 1.447-1.596), and those with a previous treatment history (aOR: 1.759, 95% CI 1.699-1.821) were prone to developing long DD (> 30 days, P < 0.05). An unfavorable outcome was negatively associated with a short DD (OR: 0.876, 95% CI 0.843-0.910, P < 0.001). Sputum smear positive rate and unfavorable outcomes were positively correlated with DD duration (Spearman correlation coefficients (rs) = 1, P < 0.001). Conclusions The DD situation remains serious; more efficient and comprehensive strategies are urgently required to minimize DD, especially for high-risk patients. Keywords: Diagnostic delay, Pulmonary tuberculosis, Trend, Poor prognosis
ISSN:1471-2466
1471-2466
DOI:10.1186/s12890-022-02101-z