Three types of delay among tuberculosis patients in China and their associations with economic factors: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yun ¹ , FANG Shilin ² ,  LU Xiaolong ² , WEN Ling ²

1. Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education; School of Public Health, Guizhou Medical University, Guiyang 550025, P. R. China;
2. School of Medicine and Health Management, Guizhou Medical University, Guiyang 550025, P. R. China;

Corresponding author：

LU Xiaolong, Email: 183637208@qq.com

Keywords：

Tuberculosis; Delay; Economic status; Meta-analysis

DOI：

10.7507/1672-2531.202112089

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the status of 3 types of delay (patient delay, diagnostic delay and treatment delay) among tuberculosis (TB) patients in China, to determine their associations with economic factors, and to provide guidance for policies regarding TB control. Methods The CNKI, WanFang Data, VIP, PubMed, ScienceDirect and Web of Science databases were searched from January 1^st, 2001, to December 31^st, 2021, for cross-sectional studies related to the 3 types of delay among TB patients in China. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using R 4.1.3 software. Results A total of 22 cross-sectional studies involving 9 498 patients were included. The results of the meta-analysis showed that the pooled rates of patient delay, diagnostic delay and treatment delay were 41% (95% CI 34% to 48%), 36% (95% CI 28% to 45%) and 18% (95% CI 10% to 32%), respectively. Family economic status was significantly associated with patient delay (OR=1.32, 95% CI 1.06 to 1.64, P=0.01), diagnostic delay (OR=1.55, 95% CI 1.21 to 1.97, P<0.01) and treatment delay (OR=1.60, 95% CI 0.98 to 2.60, P=0.05). Conclusion The rates of the 3 types of delay in Chinese TB patients are high, and all 3 types of delay are significantly associated with poor family economic status among the patients. Measures should be taken to reduce the incidence of the various types of delays due to the financial burden that is imposed on TB patients.

Citation： WANG Yun, FANG Shilin, LU Xiaolong, WEN Ling. Three types of delay among tuberculosis patients in China and their associations with economic factors: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(7): 791-798. doi: 10.7507/1672-2531.202112089 Copy

1.	刘彩霞, 方必基. 2011—2020年中国结核病研究文献计量学分析. 现代预防医学, 2021, 48(14): 2520-2523, 2551.
2.	World Health Organization. Global tuberculosis report 2020. Available at: https://www.who.int/publications/i/item/9789240013131.
3.	全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012, 34(8): 485-508.
4.	姜世闻, 王黎霞. 目标—因结核病导致家庭灾难性支出的患者为“零”. 中国防痨杂志, 2016, 38(6): 425-427.
5.	中华人民共和国国家卫生健康委员会. 关于发布《结核病分类》等两项强制性卫生行业标准的通告. Available at: http://www.nhc.gov.cn/fzs/s7852d/201711/0819ad84540b4d97a1644bbc6ec4306d.shtml.
6.	Kiwuwa MS, Charles K, Harriet MK. Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study. BMC Public Health, 2005, 5: 122.
7.	罗国良, 杨俊超, 邱志红, 等. 农村老年肺结核患者确诊延迟及其影响因素. 浙江预防医学, 2010, 22(1): 38-39.
8.	侯双翼, 肖爱清, 李国明, 等. 新发涂阳肺结核病诊断延迟分析. 中国防痨杂志, 2001, 23(4): 225-227.
9.	王红波, 尚彦萍, 丁红芳. 影响结核患者及时诊治的原因调查. 中国误诊学杂志, 2007, 7(28): 6954-6955.
10.	Wang Y, Long Q, Liu Q, et al. Treatment seeking for symptoms suggestive of TB: comparison between migrants and permanent urban residents in Chongqing, China. Trop Med Int Health, 2008, 13(7): 927-933.
11.	张景林. 黑龙江省登记新发活动性肺结核病人延迟情况分析. 黑龙江医学, 2002, 26(6): 466.
12.	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
13.	陶红霞, 金静, 阮海慧, 等. 中国老年人虐待发生率的系统评价. 中国循证医学杂志, 2020, 20(8): 938-944.
14.	张莹莹, 李旭东, 杨佳娟, 等. 中国40岁及以上人群骨关节炎患病率的Meta分析. 中国循证医学杂志, 2021, 21(4): 407-414.
15.	陈求扬, 郑金凤, 吴能健. 福建省结核病诊治延迟相关因素分析. 中国防痨杂志, 2005, 27(6): 374-379.
16.	严非. 中国结核病控制现状、问题与对策——社会评价案例研究. 上海: 复旦大学, 2007.
17.	曾伟. 安徽省巢湖市新发现肺结核病人诊治延迟影响因素及控制对策研究. 合肥: 安徽医科大学, 2011.
18.	周成超. 山东省流动人口肺结核病人求医行为及治疗管理现状与对策研究. 济南: 山东大学, 2011.
19.	曲秀坤, 楚亚林, 刘国琴, 等. 新型农村合作医疗制度下肺结核患者就诊延迟及影响因素分析. 贵州医药, 2012, 36(11): 1025-1027.
20.	赵秀秀, 徐凌忠, 郭振, 等. 山东省肺结核病人治疗延迟情况及影响因素分析. 中国卫生统计, 2013, 30(2): 187-189.
21.	楚亚林, 刘国琴, 曲秀坤, 等. 贫困边远地区结核病患者诊治延迟及影响因素调查. 中国全科医学, 2013, 16(29): 2728-2731.
22.	Tobe RG, Xu L, Zhou C, et al. Factors affecting patient delay of diagnosis and completion of Direct Observation Therapy, Short-course (DOTS) among the migrant population in Shandong, China. Biosci Trends, 2013, 7(3): 122-128.
23.	Zhao X, Yang P, Gai R, et al. Determinants of health care-seeking delay among tuberculosis patients in Shandong province, China. Eur J Public Health, 2014, 24(5): 757-761.
24.	李永红, 郭逢会, 李桂英. 影响农村结核病患者诊断意愿的因素分析及对策. 内蒙古中医药, 2014, 33(30): 124.
25.	赵颖, 罗兴能, 李廷荣, 等. 重庆市沙坪坝区肺结核病患者确诊延迟的病例对照研究. 中国社会医学杂志, 2014, 31(1): 61-63.
26.	张思源, 黄飞, 汪彦辉, 等. 家庭收入与新发涂阳肺结核诊治延迟的关系. 南京医科大学学报(社会科学版), 2015, 15(1): 39-42.
27.	林志萍, 余斌. 多维度应对方式及个体因素对肺结核患者就诊延迟的影响. 莆田学院学报, 2016, 23(5): 14-17,104.
28.	李健平. 宁夏海原县结核病控制现状及患者发现过程中的延迟影响因素分析. 银川: 宁夏医科大学, 2017.
29.	Tong Y, Guan X, Hou S, et al. Determinants of health care-seeking delay among tuberculosis patients in rural area of central China. Int J Environ Res Public Health, 2018, 15(9): 1998.
30.	马希鹏. 济宁市初治活动性肺结核患者发现延迟情况及影响因素研究. 济南: 山东大学, 2018.
31.	谢显扬, 姚若兴, 杨达书, 等. 2010-2014年平远县肺结核流行病学分析. 疾病监测与控制, 2015, 9(12): 843-845.
32.	Yang Q, Tong Y, Yin X, et al. Delays in care seeking, diagnosis and treatment of patients with pulmonary tuberculosis in Hubei, China. Int Health, 2020, 12(2): 101-106.
33.	姜婧, 孙德斌, 刘家起, 等. 沈阳市205例住院肺结核患者就诊延迟及影响因素分析. 结核病与肺部健康杂志, 2020, 9(1): 72-78.
34.	蒋骏, 张晓龙, 王斐娴, 等. 老年初治肺结核患者就诊延迟的影响因素分析. 预防医学, 2020, 32(6): 612-614,617.
35.	孔荣, 陈亮, 黄致信. 初治涂阳肺结核社会经济学调查及延误治疗的相关因素分析. 现代预防医学, 2020, 47(1): 88-92.
36.	卢星星, 刘勋, 李涛, 等. 湖北省石首市和巴东县肺结核患者就诊和卫生系统延迟情况及影响因素分析. 疾病监测, 2021, 36(10): 1010-1016.
37.	沈鸿程, 杜雨华, 张广川, 等. 2008—2018年广州市结核病患者就诊延迟影响因素分析. 中国防痨杂志, 2020, 42(5): 510-517.
38.	傅丽娟, 汪业胜, 朱文龙, 等. 湖州市2008—2018年肺结核患者就诊延迟情况及影响因素. 中华疾病控制杂志, 2021, 25(2): 235-239.
39.	吴腾燕, 刘飞鹰, 黄曙海, 等. 广西新发涂阳肺结核患者确诊延迟影响因素分析. 中国临床新医学, 2014, 7(2): 112-115.
40.	罗兴能, 贺加, 刘雄娥, 等. 重庆地区肺结核患者诊疗延迟及影响因素分析. 中国热带医学, 2013, 13(1): 39-42.
41.	Adenager GS, Alemseged F, Asefa H, et al. Factors associated with treatment delay among pulmonary tuberculosis patients in public and private health facilities in Addis Ababa, Ethiopia. Tuberc Res Treat, 2017, 2017: 5120841.
42.	Saqib SE, Ahmad MM, Amezcua-Prieto C, et al. Treatment delay among pulmonary tuberculosis patients within the Pakistan National Tuberculosis Control Program. Am J Trop Med Hyg, 2018, 99(1): 143-149.
43.	Tedla K, Medhin G, Berhe G, et al. Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia. PLoS One, 2020, 15(8): e0235411.
44.	Wondawek TM, Ali MM. Delay in treatment seeking and associated factors among suspected pulmonary tuberculosis patients in public health facilities of Adama town, eastern Ethiopia. BMC Public Health, 2019, 19(1): 1527.
45.	Li Y, Ehiri J, Tang S, et al. Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis. BMC Med, 2013, 11: 156.
46.	Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health, 2008, 8: 15.
47.	Xu CH, Jeyashree K, Shewade HD, et al. Inequity in catastrophic costs among tuberculosis-affected households in China. Infect Dis Poverty, 2019, 8(1): 46.
48.	姚阿玲. 发表偏倚对Meta分析结果影响的模拟研究. 广州: 南方医科大学, 2015.

1. 刘彩霞, 方必基. 2011—2020年中国结核病研究文献计量学分析. 现代预防医学, 2021, 48(14): 2520-2523, 2551.
2. World Health Organization. Global tuberculosis report 2020. Available at: https://www.who.int/publications/i/item/9789240013131.
3. 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012, 34(8): 485-508.
4. 姜世闻, 王黎霞. 目标—因结核病导致家庭灾难性支出的患者为“零”. 中国防痨杂志, 2016, 38(6): 425-427.
5. 中华人民共和国国家卫生健康委员会. 关于发布《结核病分类》等两项强制性卫生行业标准的通告. Available at: http://www.nhc.gov.cn/fzs/s7852d/201711/0819ad84540b4d97a1644bbc6ec4306d.shtml.
6. Kiwuwa MS, Charles K, Harriet MK. Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study. BMC Public Health, 2005, 5: 122.
7. 罗国良, 杨俊超, 邱志红, 等. 农村老年肺结核患者确诊延迟及其影响因素. 浙江预防医学, 2010, 22(1): 38-39.
8. 侯双翼, 肖爱清, 李国明, 等. 新发涂阳肺结核病诊断延迟分析. 中国防痨杂志, 2001, 23(4): 225-227.
9. 王红波, 尚彦萍, 丁红芳. 影响结核患者及时诊治的原因调查. 中国误诊学杂志, 2007, 7(28): 6954-6955.
10. Wang Y, Long Q, Liu Q, et al. Treatment seeking for symptoms suggestive of TB: comparison between migrants and permanent urban residents in Chongqing, China. Trop Med Int Health, 2008, 13(7): 927-933.
11. 张景林. 黑龙江省登记新发活动性肺结核病人延迟情况分析. 黑龙江医学, 2002, 26(6): 466.
12. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
13. 陶红霞, 金静, 阮海慧, 等. 中国老年人虐待发生率的系统评价. 中国循证医学杂志, 2020, 20(8): 938-944.
14. 张莹莹, 李旭东, 杨佳娟, 等. 中国40岁及以上人群骨关节炎患病率的Meta分析. 中国循证医学杂志, 2021, 21(4): 407-414.
15. 陈求扬, 郑金凤, 吴能健. 福建省结核病诊治延迟相关因素分析. 中国防痨杂志, 2005, 27(6): 374-379.
16. 严非. 中国结核病控制现状、问题与对策——社会评价案例研究. 上海: 复旦大学, 2007.
17. 曾伟. 安徽省巢湖市新发现肺结核病人诊治延迟影响因素及控制对策研究. 合肥: 安徽医科大学, 2011.
18. 周成超. 山东省流动人口肺结核病人求医行为及治疗管理现状与对策研究. 济南: 山东大学, 2011.
19. 曲秀坤, 楚亚林, 刘国琴, 等. 新型农村合作医疗制度下肺结核患者就诊延迟及影响因素分析. 贵州医药, 2012, 36(11): 1025-1027.
20. 赵秀秀, 徐凌忠, 郭振, 等. 山东省肺结核病人治疗延迟情况及影响因素分析. 中国卫生统计, 2013, 30(2): 187-189.
21. 楚亚林, 刘国琴, 曲秀坤, 等. 贫困边远地区结核病患者诊治延迟及影响因素调查. 中国全科医学, 2013, 16(29): 2728-2731.
22. Tobe RG, Xu L, Zhou C, et al. Factors affecting patient delay of diagnosis and completion of Direct Observation Therapy, Short-course (DOTS) among the migrant population in Shandong, China. Biosci Trends, 2013, 7(3): 122-128.
23. Zhao X, Yang P, Gai R, et al. Determinants of health care-seeking delay among tuberculosis patients in Shandong province, China. Eur J Public Health, 2014, 24(5): 757-761.
24. 李永红, 郭逢会, 李桂英. 影响农村结核病患者诊断意愿的因素分析及对策. 内蒙古中医药, 2014, 33(30): 124.
25. 赵颖, 罗兴能, 李廷荣, 等. 重庆市沙坪坝区肺结核病患者确诊延迟的病例对照研究. 中国社会医学杂志, 2014, 31(1): 61-63.
26. 张思源, 黄飞, 汪彦辉, 等. 家庭收入与新发涂阳肺结核诊治延迟的关系. 南京医科大学学报(社会科学版), 2015, 15(1): 39-42.
27. 林志萍, 余斌. 多维度应对方式及个体因素对肺结核患者就诊延迟的影响. 莆田学院学报, 2016, 23(5): 14-17,104.
28. 李健平. 宁夏海原县结核病控制现状及患者发现过程中的延迟影响因素分析. 银川: 宁夏医科大学, 2017.
29. Tong Y, Guan X, Hou S, et al. Determinants of health care-seeking delay among tuberculosis patients in rural area of central China. Int J Environ Res Public Health, 2018, 15(9): 1998.
30. 马希鹏. 济宁市初治活动性肺结核患者发现延迟情况及影响因素研究. 济南: 山东大学, 2018.
31. 谢显扬, 姚若兴, 杨达书, 等. 2010-2014年平远县肺结核流行病学分析. 疾病监测与控制, 2015, 9(12): 843-845.
32. Yang Q, Tong Y, Yin X, et al. Delays in care seeking, diagnosis and treatment of patients with pulmonary tuberculosis in Hubei, China. Int Health, 2020, 12(2): 101-106.
33. 姜婧, 孙德斌, 刘家起, 等. 沈阳市205例住院肺结核患者就诊延迟及影响因素分析. 结核病与肺部健康杂志, 2020, 9(1): 72-78.
34. 蒋骏, 张晓龙, 王斐娴, 等. 老年初治肺结核患者就诊延迟的影响因素分析. 预防医学, 2020, 32(6): 612-614,617.
35. 孔荣, 陈亮, 黄致信. 初治涂阳肺结核社会经济学调查及延误治疗的相关因素分析. 现代预防医学, 2020, 47(1): 88-92.
36. 卢星星, 刘勋, 李涛, 等. 湖北省石首市和巴东县肺结核患者就诊和卫生系统延迟情况及影响因素分析. 疾病监测, 2021, 36(10): 1010-1016.
37. 沈鸿程, 杜雨华, 张广川, 等. 2008—2018年广州市结核病患者就诊延迟影响因素分析. 中国防痨杂志, 2020, 42(5): 510-517.
38. 傅丽娟, 汪业胜, 朱文龙, 等. 湖州市2008—2018年肺结核患者就诊延迟情况及影响因素. 中华疾病控制杂志, 2021, 25(2): 235-239.
39. 吴腾燕, 刘飞鹰, 黄曙海, 等. 广西新发涂阳肺结核患者确诊延迟影响因素分析. 中国临床新医学, 2014, 7(2): 112-115.
40. 罗兴能, 贺加, 刘雄娥, 等. 重庆地区肺结核患者诊疗延迟及影响因素分析. 中国热带医学, 2013, 13(1): 39-42.
41. Adenager GS, Alemseged F, Asefa H, et al. Factors associated with treatment delay among pulmonary tuberculosis patients in public and private health facilities in Addis Ababa, Ethiopia. Tuberc Res Treat, 2017, 2017: 5120841.
42. Saqib SE, Ahmad MM, Amezcua-Prieto C, et al. Treatment delay among pulmonary tuberculosis patients within the Pakistan National Tuberculosis Control Program. Am J Trop Med Hyg, 2018, 99(1): 143-149.
43. Tedla K, Medhin G, Berhe G, et al. Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia. PLoS One, 2020, 15(8): e0235411.
44. Wondawek TM, Ali MM. Delay in treatment seeking and associated factors among suspected pulmonary tuberculosis patients in public health facilities of Adama town, eastern Ethiopia. BMC Public Health, 2019, 19(1): 1527.
45. Li Y, Ehiri J, Tang S, et al. Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis. BMC Med, 2013, 11: 156.
46. Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health, 2008, 8: 15.
47. Xu CH, Jeyashree K, Shewade HD, et al. Inequity in catastrophic costs among tuberculosis-affected households in China. Infect Dis Poverty, 2019, 8(1): 46.
48. 姚阿玲. 发表偏倚对Meta分析结果影响的模拟研究. 广州: 南方医科大学, 2015.

Chinese Journal of Evidence-Based Medicine

Three types of delay among tuberculosis patients in China and their associations with economic factors: a meta-analysis

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