Determinants of patient delay among tuberculosis cases in Spain.

Unidad de Investigación en TB, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
The European Journal of Public Health (Impact Factor: 2.59). 06/2004; 14(2):151-5.
Source: PubMed


Patient delay was investigated in a cohort of TB patients identified from May 1996 until April 1997 in 13 Autonomous Regions in Spain. The study covered almost 67% of the total Spanish population.
Data were collected from clinical records. Using unconditional logistic regression with two different cut-off points to define 'patient delay' (the median and 75th percentile), the association between patient delay and different factors was estimated.
A total of 7,037 cases were included. Median and 75th percentile delays were 22 and 57 days respectively. Factors associated with patient delay greater than the median (p<0.05) were: non-respiratory symptoms of TB and age over 14 years, although the effect of age was not linear. Furthermore, an interaction was observed between intravenous drug user (IDU) and HIV status, in that, whereas patient delay was greater in IDUs than in non-IDUs among cases whose HIV status was either negative or unknown, among HIV-positive patients no such IDU-related differences were in evidence. Factors associated with extreme patient delay (greater than the 75th percentile) were essentially the same, but the above-described interaction disappeared, with IDU status showing no direct effect. In addition, likelihood of extreme patient delay increased in the case of alcoholism and female gender and decreased in the case of chronic renal failure, corticoid treatment, prison inmates and residents of old age homes.
Although there is a universally enjoyed right to health care in Spain, some groups of TB patients could nevertheless be experiencing problems in seeking medical attention.

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    • "In accordance with previous studies [8] [12] [13] [14], we evaluated: " patient delay " (PD), i.e. the time from onset of the first symptom(s), possibly related to PTB, to the first contact with any type of healthcare service (formal or informal); " health system delay " (HSD), i.e. the time from patient's first contact with healthcare services to the date of diagnosis or the date of the start of treatment, whichever date came first. The total delay (TD) was defined as the sum of the PD and of HSD. "
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    • "This highlights the need for enlightening society regarding cough as an important TB symptom, which necessitates health care seeking more rapidly. Although the strengths of the study included the fact that, unlike in most series [5] [17] [20], we succeeded in including all but 2 eligible patients, further studies are needed to show why some symptoms accompany heightened risk of delay and others do not. "
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