热带病与寄生虫学

热带病与寄生虫学 ›› 2026, Vol. 24 ›› Issue (2): 80-84,104.doi: 10.20199/j.issn.1672-2302.2026.02.004

• 结核病防控专题 • 上一篇    下一篇

2020—2024年重庆市65岁及以上肺结核患者就诊及确诊延迟影响因素分析

张理翌(), 廖文平(), 张文(), 苏倩   

  1. 重庆市结核病防治所， 重庆 400050
  • 收稿日期:2025-10-20 出版日期:2026-04-20 发布日期:2026-05-29
  • 通信作者: 张文，E-mail: zhanghenwen@163.com
  • 作者简介:张理翌，女，本科，心理治疗师，研究方向：结核病防控。E-mail: 416759505@qq.com；|廖文平，女，本科，主治医师，研究方向：结核病防控。E-mail: 2473885626@qq.com
  • 基金资助:
    重庆市九龙坡区科技计划项目(2024-04-023-Y);重庆市九龙坡区科技计划项目(2024-04-002-Z);重庆市疾控局疾控科研项目(2026JKXM037)

Influencing factors for medical visit and diagnosis delay in the tuberculosis patients aged 65 and above in Chongqing Municipality, 2020-2024

ZHANG Liyi(), LIAO Wenping(), ZHANG Wen(), SU Qian   

  1. Chongqing Institute of Tuberculosis Control and Prevention, Chongqing 400050, China
  • Received:2025-10-20 Online:2026-04-20 Published:2026-05-29
  • Contact: ZHANG Wen, E-mail: zhanghenwen@163.com

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摘要：

目的 分析重庆市65岁及以上肺结核患者就诊及确诊延迟影响因素，为老年肺结核病防治工作提供参考。方法 通过中国疾病预防控制信息系统收集2020—2024年重庆市65岁及以上肺结核患者病案资料，运用Joinpoint回归模型进行时间趋势分析，采用χ2检验和多因素logistic回归分析就诊及确诊延迟的影响因素。结果 2020—2024年重庆市纳入研究的65岁及以上肺结核患者21 910例。其中，16 504例患者存在就诊延迟，就诊延迟率为75.33%；2 555例患者存在确诊延迟，确诊延迟率为11.66%。Joinpoint回归分析显示，2020—2024年患者就诊延迟率整体无明显趋势（APC=1.99%，95%CI：-2.26%~6.82%，P>0.05）；确诊延迟率呈现先升后降趋势，2020—2022年快速上升（APC=14.54%，95%CI：10.36%~19.39%，P<0.001），2022—2024年明显下降（APC=-6.96%，95%CI：-10.62%~-3.48%，P<0.001）。多因素logistic回归分析显示，女性（OR=1.11，95%CI：1.03~1.20）、非重点人群（OR=1.11，95%CI：1.03~1.19）发生就诊延迟的风险更高，≥80岁（OR=0.88，95%CI：0.80~0.96）、非农民（OR=0.71，95%CI：0.67~0.76）、复治（OR=0.80，95%CI：0.73~0.88）发生就诊延迟的风险更低；少数民族（OR=4.65，95%CI：3.59~6.02）、非本地户籍（OR=1.80，95%CI：1.47~2.20）、非农民（OR=1.63，95%CI：1.49~1.78）、复治（OR=1.54，95%CI：1.36~1.73）发生确诊延迟的风险更高，女性（OR=0.88，95%CI：0.80~0.98），70~74岁（OR=0.88，95%CI：0.79~0.97）、75~79岁（OR=0.88，95%CI：0.79~0.99）以及≥80岁（OR=0.81，95%CI：0.71~0.93）年龄组，病原学结果阳性（OR=0.77，95%CI：0.70~0.85）发生确诊延迟的风险更低。结论 重庆市老年肺结核患者就诊及确诊延迟率仍较高；女性、非重点人群是发生就诊延迟的危险因素，非本地户籍、少数民族、非农民、复治患者是发生确诊延迟的危险因素。今后应对以上人群加强健康宣教、提高主动筛查力度，同时提高医疗机构诊疗能力和服务可及性，实现早发现、早诊断。

关键词: 肺结核, 老年人, 就诊延迟, 确诊延迟, 重庆市

Abstract:

Objective To analyze the influencing factors of medical consultation and diagnosis delay among pulmonary tuberculosis patients aged 65 years and above in Chongqing for evidences for the prevention and treatment of the elderly pulmonary tuberculosis. Methods Medical record data of pulmonary tuberculosis patients aged 65 years and above in Chongqing were obtained from 2020 to 2024 through the Chinese Disease Prevention and Control Information System. Joinpoint regression model was used for temporal trend analysis. Chi-square test and multivariate logistic regression were applied to analyze the influencing factors of delayed medical visit and diagnosis. Results A total of 21 910 pulmonary tuberculosis patients aged 65 years and over in Chongqing area were included in this study from 2020 to 2024. Among these subjects, 16 504 had medical consultation delay, with a delay rate of 75.33%, and 2 555 had diagnosis delay, with a delay rate of 11.66%. Joinpoint regression analysis showed that the overall medical visit delay rate presented no significant temporal trend from 2020 to 2024 (APC=1.99%, 95%CI: -2.26% to 6.82%, P>0.05). The diagnosis delay rate showed an overall trend by rising first and then declining, which increased rapidly from 2020 to 2022 (APC=14.54%, 95%CI: 10.36% to 19.39%, P<0.001), and decreased significantly from 2022 to 2024 (APC=-6.96%, 95%CI: -10.62% to -3.48%, P<0.001). Multivariate logistic regression analysis indicated that female gender (OR=1.11, 95%CI: 1.03 to 1.20) and non-key population (OR=1.11, 95%CI: 1.03 to 1.19) were associated with a higher risk of medical consultation delay, whereas aged ≥80 years (OR=0.88, 95%CI: 0.80 to 0.96), non-farmer occupation (OR=0.71, 95%CI: 0.67 to 0.76) and retreated cases (OR=0.80, 95%CI: 0.73 to 0.88) were linked to a lower risk of medical consultation delay. Higher risks of diagnosis delay were found in ethnic minorities (OR=4.65, 95%CI: 3.59 to 6.02), non-local household registration (OR=1.80, 95%CI: 1.47 to 2.20), non-farmer occupation (OR=1.63, 95%CI: 1.49 to 1.78) and retreatment cases (OR=1.54, 95%CI: 1.36 to 1.73). In contrast, female gender (OR=0.88, 95%CI: 0.80 to 0.98), age groups of 70-74 years (OR=0.88, 95%CI: 0.79 to 0.97), 75-79 years (OR=0.88, 95%CI: 0.79 to 0.99) and ≥80 years (OR=0.81, 95%CI: 0.71 to 0.93), as well as positive etiological testing results (OR=0.77, 95%CI: 0.70 to 0.85) corresponded to a lower risk of delayed diagnosis. Conclusion The rates of medical visit and diagnosis delay remain relatively higher among the elderly patients with pulmonary tuberculosis in Chongqing area. Female gender and non-key population are prone to delayed medical consultation, and diagnosis delay is more seen in non-local household registration, ethnic minorities, non-farmers and retreated patients. These findings suggest that targeted health education and active screening should be strengthened for the above high-risk groups in following tasks. Meanwhile, medical institutions shall improve their diagnosis and treatment capacity as well as service accessibility to realize early detection and early diagnosis of pulmonary tuberculosis in the older population of our area.

Key words: Pulmonary tuberculosis, The elderly, Medical visit delay, Diagnosis delay, Chongqing Municipality

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