Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal

Abstract Background Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the p...

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Autores principales:	João Almeida Santos, Andreia Leite, Patrícia Soares, Raquel Duarte, Carla Nunes
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Pulmonary tuberculosis Patient delay Healthcare delay Total delay Tuberculosis control Public health Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/997428ede85e44d6b2d499e9b49d6911
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spelling	oai:doaj.org-article:997428ede85e44d6b2d499e9b49d69112021-11-28T12:12:37ZDelayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal10.1186/s12889-021-12245-y1471-2458https://doaj.org/article/997428ede85e44d6b2d499e9b49d69112021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12245-yhttps://doaj.org/toc/1471-2458Abstract Background Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis. Methods Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05. Results Median patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19–71), 8 days (IQR: 1–32) and 62 days (IQR: 38–102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay. Conclusions Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.João Almeida SantosAndreia LeitePatrícia SoaresRaquel DuarteCarla NunesBMCarticlePulmonary tuberculosisPatient delayHealthcare delayTotal delayTuberculosis controlPublic healthPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pulmonary tuberculosis Patient delay Healthcare delay Total delay Tuberculosis control Public health Public aspects of medicine RA1-1270
spellingShingle	Pulmonary tuberculosis Patient delay Healthcare delay Total delay Tuberculosis control Public health Public aspects of medicine RA1-1270 João Almeida Santos Andreia Leite Patrícia Soares Raquel Duarte Carla Nunes Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal
description	Abstract Background Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis. Methods Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05. Results Median patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19–71), 8 days (IQR: 1–32) and 62 days (IQR: 38–102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay. Conclusions Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.
format	article
author	João Almeida Santos Andreia Leite Patrícia Soares Raquel Duarte Carla Nunes
author_facet	João Almeida Santos Andreia Leite Patrícia Soares Raquel Duarte Carla Nunes
author_sort	João Almeida Santos
title	Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal
title_short	Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal
title_full	Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal
title_fullStr	Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal
title_full_unstemmed	Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal
title_sort	delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in portugal
publisher	BMC
publishDate	2021
url	https://doaj.org/article/997428ede85e44d6b2d499e9b49d6911
work_keys_str_mv	AT joaoalmeidasantos delayeddiagnosisofactivepulmonarytuberculosispotentialriskfactorsforpatientandhealthcaredelaysinportugal AT andreialeite delayeddiagnosisofactivepulmonarytuberculosispotentialriskfactorsforpatientandhealthcaredelaysinportugal AT patriciasoares delayeddiagnosisofactivepulmonarytuberculosispotentialriskfactorsforpatientandhealthcaredelaysinportugal AT raquelduarte delayeddiagnosisofactivepulmonarytuberculosispotentialriskfactorsforpatientandhealthcaredelaysinportugal AT carlanunes delayeddiagnosisofactivepulmonarytuberculosispotentialriskfactorsforpatientandhealthcaredelaysinportugal
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Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal

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