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Sun R, Wu Z, Zhang H, Huang J, Liu Y, Chen M, Lv Y, Zhao F, Zhang Y, Li M, Yan J, Jiang H, Zhan Y, Xu J, Xu Y, Yuan J, Zhao Y, Shen X, Yang C. Assessing heterogeneity of patient and health system delay among TB in a population with internal migrants in China. Front Public Health 2024; 12:1354515. [PMID: 38371243 PMCID: PMC10869454 DOI: 10.3389/fpubh.2024.1354515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Backgrounds The diagnostic delay of tuberculosis (TB) contributes to further transmission and impedes the implementation of the End TB Strategy. Therefore, we aimed to describe the characteristics of patient delay, health system delay, and total delay among TB patients in Shanghai, identify areas at high risk for delay, and explore the potential factors of long delay at individual and spatial levels. Method The study included TB patients among migrants and residents in Shanghai between January 2010 and December 2018. Patient and health system delays exceeding 14 days and total delays exceeding 28 days were defined as long delays. Time trends of long delays were evaluated by Joinpoint regression. Multivariable logistic regression analysis was employed to analyze influencing factors of long delays. Spatial analysis of delays was conducted using ArcGIS, and the hierarchical Bayesian spatial model was utilized to explore associated spatial factors. Results Overall, 61,050 TB patients were notified during the study period. Median patient, health system, and total delays were 12 days (IQR: 3-26), 9 days (IQR: 4-18), and 27 days (IQR: 15-43), respectively. Migrants, females, older adults, symptomatic visits to TB-designated facilities, and pathogen-positive were associated with longer patient delays, while pathogen-negative, active case findings and symptomatic visits to non-TB-designated facilities were associated with long health system delays (LHD). Spatial analysis revealed Chongming Island was a hotspot for patient delay, while western areas of Shanghai, with a high proportion of internal migrants and industrial parks, were at high risk for LHD. The application of rapid molecular diagnostic methods was associated with reduced health system delays. Conclusion Despite a relatively shorter diagnostic delay of TB than in the other regions in China, there was vital social-demographic and spatial heterogeneity in the occurrence of long delays in Shanghai. While the active case finding and rapid molecular diagnosis reduced the delay, novel targeted interventions are still required to address the challenges of TB diagnosis among both migrants and residents in this urban setting.
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Affiliation(s)
- Ruoyao Sun
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Zheyuan Wu
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Hongyin Zhang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jinrong Huang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yueting Liu
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Meiru Chen
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yixiao Lv
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, China
| | - Yangyi Zhang
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Minjuan Li
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jiaqi Yan
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Hongbing Jiang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yiqiang Zhan
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jimin Xu
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yanzi Xu
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Jianhui Yuan
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Yang Zhao
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Xin Shen
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Institutes of Preventive Medicine, Shanghai, China
| | - Chongguang Yang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, Guangdong Province, China
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Qin S, Ni X, Ding Y. Factors Associated with the Delay in Seeing a Doctor: Evidence of Chinese Middle-Aged and Older Adults. J Multidiscip Healthc 2023; 16:4239-4253. [PMID: 38164460 PMCID: PMC10758318 DOI: 10.2147/jmdh.s443683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Background There have been few studies concerning delayed medical attention among middle-aged and older adults, and in-depth analyses of delay duration and symptoms have been lacking. Methods In this cross-sectional study exploiting a face-to-face questionnaire survey, we investigated delays in seeing a doctor among ≥ 45-year-old people in Zhejiang, China over the past year, and analyzed relevant influencing factors through logistics regression. Results A total of 1034 people aged ≥45 years were enrolled, whose overall occurrence of delay in seeing a doctor was 28.24% (23.00% for older adults aged ≥60 years). Factors like the presence of 2 chronic diseases, intense social loneliness, and more health care needs contributed to the occurrence of delay in seeing a doctor (OR (95% CI) = 2.102 (1.252-3.529); OR (95% CI) = 1.030 (1.002-1.059); OR (95% CI) = 1.049 (1.002-1.099). Contrastively, factors like convenient access to medical care and good self-reported health status inhibited such occurrence OR (95% CI) = 0.321 (0.199-0.519); OR (95% CI) = 0.369 (0.183-0.745). The foremost reason was wanting to wait and see if the problem would get better on its own (117, 40.07%). Respiratory system disease (14.90%), dental problems (13.82%), and cardiac disease (13.61%) constituted the top 3 types of diseases whose treatments were delayed. Additionally, for the majority of older adults, the delay duration was 1-2 weeks (99, 33.90%), and the economic burden was the cause of the longest delay in seeing a doctor among middle-aged and older adults. Conclusion To alleviate the problem of delay in seeing a doctor among middle-aged and older adults, their families and society should enhance care for them and reduce their sense of social loneliness. Emphasis should be placed by the government on helping middle-aged and older adults with financial difficulties so that their medical convenience can be improved.
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Affiliation(s)
- Shangren Qin
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaoyan Ni
- Cangqian Street Community Health Service Center, Hangzhou, Zhejiang, People’s Republic of China
| | - Ye Ding
- School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
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