Factors Associated With Diagnostic Delay of Pulmonary Tuberculosis in China

Background Tuberculosis (TB) is still a great challenge to public health in China. Most of the transmission occurs between the onset of symptoms and initiation of treatment. Diagnosis delay is a major barrier to effective management of the disease. Determining the factors associated with patient and provider delay of TB diagnosis and treatment may contribute to TB prevention and control.MethodsA cross-sectional survey of pulmonary tuberculosis registed in the National Tuberculosis programme was conducted in 22 counties of 6 provinces in China. All consecutively registered patients during January to June 2017 were interviewed using a structured questionnaire. The time from the onset of symptoms to the date of diagnosis was analyzed. Bivariate and logistics regression were applied to analyze the risk factors of delay.ResultsThe median time from onset of symptoms to diagnosis was 23 days (interquartile range [IQR]: 5-53days). The risk of delayed diagnosis was higher in the central (OR=3.27, 95%CI 1.39-7.68) and eastern regions (OR=1.48, 95%CI 1.04-2.10) than in the western regions. Rural TB patients have a longer diagnosis delay than those in urban areas (OR=1.44, 95%CI 1.00-2.08). The asymptomatic TB patients had a longer diagnosis delay than TB patients with clinical symptoms (OR=0.20, 95%CI 0.13-0.31).ConclusionsA high propotion of TB patients showed diagnostic delay in China especially in some low economic level areas. Multiple measures should be taken to shorten the delay, such as to increase public awareness of the disease and expansion the quality assured facility in economic less-developed regions.Trial registrationNot applicable