Reina Yoshikawa1, Lisa Kawatsu2, Kazuhiro Uchimura2, Akihiro Ohkado2,3. 1. Department of General Internal Medicine, Rakuwakai Marutamachi Hospital, Kyoto, Japan. 2. Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan. 3. Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Abstract
OBJECTIVE: To study the trends in and risk factors for patient delay (the time from the onset of symptoms to the initial doctor visit) in pulmonary tuberculosis (PTB) using three temporal categories - short (2 weeks to < 2 months), medium (2 months to < 6 months) and long (≥ 6 months) - and discuss implications for social protection measures. METHODS: A descriptive cross-sectional study was conducted by analysing Japanese TB surveillance data from patients with symptomatic PTB registered between 2007 and 2017 (n = 88 351). RESULTS: While the proportion of patients with short delay has decreased significantly (P < 0.001), the proportions of those with medium or long delays have decreased slightly (P = 0.0015 and P < 0.001, respectively). Not having health insurance, receiving public assistance, being a temporary worker, and having a history of homelessness were some of the risks identified for patient delay. Being male and working full-time were two risks specifically associated with long delay (for males, the adjusted odds ratio = 1.17, P < 0.05; for being a full-time worker, the adjusted odds ratio = 1.72, P < 0.05). DISCUSSION: Despite the implementation of universal health coverage decades ago, patient delay remains a challenge in Japan. Our study identified various risk factors, many of which could have been resolved if appropriate social protection measures were in place, indicating shortcomings in universal health coverage in Japan and the need for continued effort to ensure that no one is left behind. (c) 2020 The authors; licensee World Health Organization.
OBJECTIVE: To study the trends in and risk factors for patient delay (the time from the onset of symptoms to the initial doctor visit) in pulmonary tuberculosis (PTB) using three temporal categories - short (2 weeks to < 2 months), medium (2 months to < 6 months) and long (≥ 6 months) - and discuss implications for social protection measures. METHODS: A descriptive cross-sectional study was conducted by analysing Japanese TB surveillance data from patients with symptomatic PTB registered between 2007 and 2017 (n = 88 351). RESULTS: While the proportion of patients with short delay has decreased significantly (P < 0.001), the proportions of those with medium or long delays have decreased slightly (P = 0.0015 and P < 0.001, respectively). Not having health insurance, receiving public assistance, being a temporary worker, and having a history of homelessness were some of the risks identified for patient delay. Being male and working full-time were two risks specifically associated with long delay (for males, the adjusted odds ratio = 1.17, P < 0.05; for being a full-time worker, the adjusted odds ratio = 1.72, P < 0.05). DISCUSSION: Despite the implementation of universal health coverage decades ago, patient delay remains a challenge in Japan. Our study identified various risk factors, many of which could have been resolved if appropriate social protection measures were in place, indicating shortcomings in universal health coverage in Japan and the need for continued effort to ensure that no one is left behind. (c) 2020 The authors; licensee World Health Organization.
Authors: M Ohmori; K Ozasa; T Mori; M Wada; T Yoshiyama; M Aoki; K Uchimura; N Ishikawa Journal: Int J Tuberc Lung Dis Date: 2005-09 Impact factor: 2.373
Authors: Y Lin; D A Enarson; C-Y Chiang; I D Rusen; L-X Qiu; X-H Kan; Y-L Yuan; J Du; T-H Zhang; Y Li; X-F Li; C-T Du; L-X Zhang Journal: Public Health Action Date: 2015-03-21
Authors: Katherine C Horton; Tom Sumner; Rein M G J Houben; Elizabeth L Corbett; Richard G White Journal: Am J Epidemiol Date: 2018-11-01 Impact factor: 4.897