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