摘要
目的探讨医务人员、教师初治涂阳肺结核患者发现延迟情况。方法以河南省近年来报告的681例职业为医务人员与教师的初治涂阳肺结核患者(其中医务人员356例,教师325例)为研究对象,同时按照登记号相邻原则以每1例教师患者抽取2例农民患者,共抽取650例职业为农民的初治肺结核患者作为对照,采用中位数、延迟率等为指标,对三组患者的发现延迟包括就诊、确诊延迟情况进行描述与比较,应用Logistic回归模型探讨了其影响因素。结果医务人员、教师、农民三组患者发现延迟时间中位数分别为24、20、29天,差异具有统计学意义(P<0.05);2周以上就诊延迟率分别为48.0%、44.6%、47.4%,差异无统计学意义(P>0.05);2周以上确诊延迟率分别为18.0%、16.9%、25.7%,4周以上发现延迟率分别为44.9%、41.2%、51.8%,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,患者发现途径、职业、户籍是否本县/区与4周以上发现延迟相关;以因症到结核病定点医疗机构就诊途径为参照,因症推荐、追踪、转诊的校正OR(95%CI)分别为1.6(1.0~2.7)、1.8(1.2~2.7)、0.7(0.6~0.9);以农民患者组为参照,医务人员与教师组的校正OR(95%CI)为0.8(0.6~1.0)、0.7(0.5~0.9);以本县/区户籍为参照,非本县/区户籍的校正OR(95%CI)为1.6(1.2~2.2)。结论河南省医务人员与教师初治涂阳肺结核患者的发现延迟时间、延迟率明显低于农民患者,然而40%以上医务人员与教师初治涂阳肺结核患者在发病4周以后被发现,作为容易导致聚集性感染发病的特殊职业人群,其发现延迟更应引起重视;户籍不在本县区、因症推荐与追踪患者发现途径增加了患者发现延迟,而转诊有助于减少患者发现延迟。
Objective To understand the detection-delay status of new smear-positive pulmonary tuberculosis(NSPPTB)cases among health-care workers(HCWs)and teachers,and the factors associated with the delay.Methods Totally 681 NSPPTB cases,356 with the occupation of HCW and 325 with the occupation of teacher reported from Henan during recent years were recruited as study subjects,and 650 cases with the occupation of farmer selected based on registration number neighbor to the teacher cases with 2 farmer cases matched to 1 teacher case,were regarded as controls.The cases information related were extracted from the national TB information management system.Median of delay days and proportion of cases with delay days over 1~4 weeks were used to assess the status of detection delay including health-care seeking delay(HCSD),and confirming diagnosis delay(CDD).Results Medians of detection-delay days among HCW,teacher and farmer cases were 24,20,and 29,respectively,and the difference was statistically significant(P<0.05);The proportions of cases with HCSD over two weeks among HCWs,teachers and farmers were 48.0%,44.6%and 47.4%,respectively,with no statistically significant difference(P>0.05).The proportions of cases with CDD over 2 weeks among HCWs,teachers and farmers were 18.0%,16.9%and 25.7%,and the proportions of cases with detection delay over 4 weeks among HCWs,teachers and farmers were 44.9%,41.2%and 51.8%,respectively,and both had statistically significant difference(all P<0.05).Multivariate Logistic regression analysis results showed that case detection path,occupation and residence were associated with detection delay over 4 weeks in a statistically significant way.Regarding the group“voluntarily seeing TB doctor due to symptom”as reference,the adjusted ORs(95%CI)for groups“referral based on symptoms(RBOS)”,“referral-lost case tracking(RLCT)”and“referral based on diagnosis(RBOD)”were 1.6(1.0~2.7)、1.8(1.2~2.7)and 0.7(0.6~0.9);adjusted ORs(95%CI)was 0.8(0.6~1.0)for HCW cases and 0.7(0.5~0.9)for teacher cases regarding farmer cases as reference,and adjusted ORs(95%CI)was1.6(1.2~2.2)for“not locally-registered permanent residence(NLRPR)”regarding“locally-registered permanent residence”as reference,respectively.Conclusion Over 40%of NSPPTB cases among HCWs and teachers were detected after 4 weeks delay although the proportion was lower than that among famers,as special occupations being more likely to cause cases cluster infection,strong measures should be taken to reduce detection delay among HCW and teacher cases;NLRPR,RBOS and RLCT increased the risk of detection delay,and RBOD could reduce the risk of detection delay.
作者
王国杰
徐吉英
高三友
胡会义
王侃
庄严
杨国俊
WANG Guo-jie;XU Ji-ying;GAO San-you;HU Hui-yi;WANG Kan;ZHUANG Yan;YANG Guo-jun(Henan Medical College,Zhengzhou 451191,China;不详)
出处
《医药论坛杂志》
2021年第15期84-90,共7页
Journal of Medical Forum
关键词
肺结核
发现延迟
医务人员
教师
Pulmonary TB
Detection delay
Health-care worker
Teacher
