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.	劉彩霞, 方必基. 2011—2020年中國結核病研究文獻計量學分析. 現代預防醫學, 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.	全國第五次結核病流行病學抽樣調查辦公室. 2010年全國第五次結核病流行病學抽樣調查報告. 中國防癆雜志, 2012, 34(8): 485-508.
4.	姜世聞, 王黎霞. 目標—因結核病導致家庭災難性支出的患者為“零”. 中國防癆雜志, 2016, 38(6): 425-427.
5.	中華人民共和國國家衛生健康委員會. 關于發布《結核病分類》等兩項強制性衛生行業標準的通告. 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.	羅國良, 楊俊超, 邱志紅, 等. 農村老年肺結核患者確診延遲及其影響因素. 浙江預防醫學, 2010, 22(1): 38-39.
8.	侯雙翼, 肖愛清, 李國明, 等. 新發涂陽肺結核病診斷延遲分析. 中國防癆雜志, 2001, 23(4): 225-227.
9.	王紅波, 尚彥萍, 丁紅芳. 影響結核患者及時診治的原因調查. 中國誤診學雜志, 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.	張景林. 黑龍江省登記新發活動性肺結核病人延遲情況分析. 黑龍江醫學, 2002, 26(6): 466.
12.	曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
13.	陶紅霞, 金靜, 阮海慧, 等. 中國老年人虐待發生率的系統評價. 中國循證醫學雜志, 2020, 20(8): 938-944.
14.	張瑩瑩, 李旭東, 楊佳娟, 等. 中國40歲及以上人群骨關節炎患病率的Meta分析. 中國循證醫學雜志, 2021, 21(4): 407-414.
15.	陳求揚, 鄭金鳳, 吳能健. 福建省結核病診治延遲相關因素分析. 中國防癆雜志, 2005, 27(6): 374-379.
16.	嚴非. 中國結核病控制現狀、問題與對策——社會評價案例研究. 上海: 復旦大學, 2007.
17.	曾偉. 安徽省巢湖市新發現肺結核病人診治延遲影響因素及控制對策研究. 合肥: 安徽醫科大學, 2011.
18.	周成超. 山東省流動人口肺結核病人求醫行為及治療管理現狀與對策研究. 濟南: 山東大學, 2011.
19.	曲秀坤, 楚亞林, 劉國琴, 等. 新型農村合作醫療制度下肺結核患者就診延遲及影響因素分析. 貴州醫藥, 2012, 36(11): 1025-1027.
20.	趙秀秀, 徐凌忠, 郭振, 等. 山東省肺結核病人治療延遲情況及影響因素分析. 中國衛生統計, 2013, 30(2): 187-189.
21.	楚亞林, 劉國琴, 曲秀坤, 等. 貧困邊遠地區結核病患者診治延遲及影響因素調查. 中國全科醫學, 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.	李永紅, 郭逢會, 李桂英. 影響農村結核病患者診斷意愿的因素分析及對策. 內蒙古中醫藥, 2014, 33(30): 124.
25.	趙穎, 羅興能, 李廷榮, 等. 重慶市沙坪壩區肺結核病患者確診延遲的病例對照研究. 中國社會醫學雜志, 2014, 31(1): 61-63.
26.	張思源, 黃飛, 汪彥輝, 等. 家庭收入與新發涂陽肺結核診治延遲的關系. 南京醫科大學學報(社會科學版), 2015, 15(1): 39-42.
27.	林志萍, 余斌. 多維度應對方式及個體因素對肺結核患者就診延遲的影響. 莆田學院學報, 2016, 23(5): 14-17,104.
28.	李健平. 寧夏海原縣結核病控制現狀及患者發現過程中的延遲影響因素分析. 銀川: 寧夏醫科大學, 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.	馬希鵬. 濟寧市初治活動性肺結核患者發現延遲情況及影響因素研究. 濟南: 山東大學, 2018.
31.	謝顯揚, 姚若興, 楊達書, 等. 2010-2014年平遠縣肺結核流行病學分析. 疾病監測與控制, 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, 孫德斌, 劉家起, 等. 沈陽市205例住院肺結核患者就診延遲及影響因素分析. 結核病與肺部健康雜志, 2020, 9(1): 72-78.
34.	蔣駿, 張曉龍, 王斐嫻, 等. 老年初治肺結核患者就診延遲的影響因素分析. 預防醫學, 2020, 32(6): 612-614,617.
35.	孔榮, 陳亮, 黃致信. 初治涂陽肺結核社會經濟學調查及延誤治療的相關因素分析. 現代預防醫學, 2020, 47(1): 88-92.
36.	盧星星, 劉勛, 李濤, 等. 湖北省石首市和巴東縣肺結核患者就診和衛生系統延遲情況及影響因素分析. 疾病監測, 2021, 36(10): 1010-1016.
37.	沈鴻程, 杜雨華, 張廣川, 等. 2008—2018年廣州市結核病患者就診延遲影響因素分析. 中國防癆雜志, 2020, 42(5): 510-517.
38.	傅麗娟, 汪業勝, 朱文龍, 等. 湖州市2008—2018年肺結核患者就診延遲情況及影響因素. 中華疾病控制雜志, 2021, 25(2): 235-239.
39.	吳騰燕, 劉飛鷹, 黃曙海, 等. 廣西新發涂陽肺結核患者確診延遲影響因素分析. 中國臨床新醫學, 2014, 7(2): 112-115.
40.	羅興能, 賀加, 劉雄娥, 等. 重慶地區肺結核患者診療延遲及影響因素分析. 中國熱帶醫學, 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. 發表偏倚對Meta分析結果影響的模擬研究. 廣州: 南方醫科大學, 2015.

1. 劉彩霞, 方必基. 2011—2020年中國結核病研究文獻計量學分析. 現代預防醫學, 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. 全國第五次結核病流行病學抽樣調查辦公室. 2010年全國第五次結核病流行病學抽樣調查報告. 中國防癆雜志, 2012, 34(8): 485-508.
4. 姜世聞, 王黎霞. 目標—因結核病導致家庭災難性支出的患者為“零”. 中國防癆雜志, 2016, 38(6): 425-427.
5. 中華人民共和國國家衛生健康委員會. 關于發布《結核病分類》等兩項強制性衛生行業標準的通告. 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. 羅國良, 楊俊超, 邱志紅, 等. 農村老年肺結核患者確診延遲及其影響因素. 浙江預防醫學, 2010, 22(1): 38-39.
8. 侯雙翼, 肖愛清, 李國明, 等. 新發涂陽肺結核病診斷延遲分析. 中國防癆雜志, 2001, 23(4): 225-227.
9. 王紅波, 尚彥萍, 丁紅芳. 影響結核患者及時診治的原因調查. 中國誤診學雜志, 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. 張景林. 黑龍江省登記新發活動性肺結核病人延遲情況分析. 黑龍江醫學, 2002, 26(6): 466.
12. 曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
13. 陶紅霞, 金靜, 阮海慧, 等. 中國老年人虐待發生率的系統評價. 中國循證醫學雜志, 2020, 20(8): 938-944.
14. 張瑩瑩, 李旭東, 楊佳娟, 等. 中國40歲及以上人群骨關節炎患病率的Meta分析. 中國循證醫學雜志, 2021, 21(4): 407-414.
15. 陳求揚, 鄭金鳳, 吳能健. 福建省結核病診治延遲相關因素分析. 中國防癆雜志, 2005, 27(6): 374-379.
16. 嚴非. 中國結核病控制現狀、問題與對策——社會評價案例研究. 上海: 復旦大學, 2007.
17. 曾偉. 安徽省巢湖市新發現肺結核病人診治延遲影響因素及控制對策研究. 合肥: 安徽醫科大學, 2011.
18. 周成超. 山東省流動人口肺結核病人求醫行為及治療管理現狀與對策研究. 濟南: 山東大學, 2011.
19. 曲秀坤, 楚亞林, 劉國琴, 等. 新型農村合作醫療制度下肺結核患者就診延遲及影響因素分析. 貴州醫藥, 2012, 36(11): 1025-1027.
20. 趙秀秀, 徐凌忠, 郭振, 等. 山東省肺結核病人治療延遲情況及影響因素分析. 中國衛生統計, 2013, 30(2): 187-189.
21. 楚亞林, 劉國琴, 曲秀坤, 等. 貧困邊遠地區結核病患者診治延遲及影響因素調查. 中國全科醫學, 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. 李永紅, 郭逢會, 李桂英. 影響農村結核病患者診斷意愿的因素分析及對策. 內蒙古中醫藥, 2014, 33(30): 124.
25. 趙穎, 羅興能, 李廷榮, 等. 重慶市沙坪壩區肺結核病患者確診延遲的病例對照研究. 中國社會醫學雜志, 2014, 31(1): 61-63.
26. 張思源, 黃飛, 汪彥輝, 等. 家庭收入與新發涂陽肺結核診治延遲的關系. 南京醫科大學學報(社會科學版), 2015, 15(1): 39-42.
27. 林志萍, 余斌. 多維度應對方式及個體因素對肺結核患者就診延遲的影響. 莆田學院學報, 2016, 23(5): 14-17,104.
28. 李健平. 寧夏海原縣結核病控制現狀及患者發現過程中的延遲影響因素分析. 銀川: 寧夏醫科大學, 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. 馬希鵬. 濟寧市初治活動性肺結核患者發現延遲情況及影響因素研究. 濟南: 山東大學, 2018.
31. 謝顯揚, 姚若興, 楊達書, 等. 2010-2014年平遠縣肺結核流行病學分析. 疾病監測與控制, 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, 孫德斌, 劉家起, 等. 沈陽市205例住院肺結核患者就診延遲及影響因素分析. 結核病與肺部健康雜志, 2020, 9(1): 72-78.
34. 蔣駿, 張曉龍, 王斐嫻, 等. 老年初治肺結核患者就診延遲的影響因素分析. 預防醫學, 2020, 32(6): 612-614,617.
35. 孔榮, 陳亮, 黃致信. 初治涂陽肺結核社會經濟學調查及延誤治療的相關因素分析. 現代預防醫學, 2020, 47(1): 88-92.
36. 盧星星, 劉勛, 李濤, 等. 湖北省石首市和巴東縣肺結核患者就診和衛生系統延遲情況及影響因素分析. 疾病監測, 2021, 36(10): 1010-1016.
37. 沈鴻程, 杜雨華, 張廣川, 等. 2008—2018年廣州市結核病患者就診延遲影響因素分析. 中國防癆雜志, 2020, 42(5): 510-517.
38. 傅麗娟, 汪業勝, 朱文龍, 等. 湖州市2008—2018年肺結核患者就診延遲情況及影響因素. 中華疾病控制雜志, 2021, 25(2): 235-239.
39. 吳騰燕, 劉飛鷹, 黃曙海, 等. 廣西新發涂陽肺結核患者確診延遲影響因素分析. 中國臨床新醫學, 2014, 7(2): 112-115.
40. 羅興能, 賀加, 劉雄娥, 等. 重慶地區肺結核患者診療延遲及影響因素分析. 中國熱帶醫學, 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. 發表偏倚對Meta分析結果影響的模擬研究. 廣州: 南方醫科大學, 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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