Wenhui Xiao1, Dajiang Huang2, Saiqiong Li3, Shangcheng Zhou1, Xiaolin Wei4, Bin Chen5, Guanyang Zou6. 1. School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China. 2. Center for Disease Prevention and Control, Cangnan County, Wenzhou, Zhejiang Province, China. 3. Center for Disease Prevention and Control, Yongjia County, Wenzhou, Zhejiang Province, China. 4. Division of Clinical Epidemiology & Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 5. Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, China. bchen@cdc.zj.cn. 6. School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China. zgy1021@hotmail.com.
Abstract
BACKGROUND: Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay. METHODS: Data was collected from China's Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system's respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM. RESULTS: Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008-11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582-36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days. CONCLUSIONS: Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.
BACKGROUND:Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay. METHODS: Data was collected from China's Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system's respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM. RESULTS: Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008-11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582-36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days. CONCLUSIONS: Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabeticpatients and of strengthening the integrated control and management of TB and diabetic programs.
Authors: A D Harries; A M V Kumar; S Satyanarayana; Y Lin; R Zachariah; K Lönnroth; A Kapur Journal: Int J Tuberc Lung Dis Date: 2015-08 Impact factor: 2.373