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背景:中国一个山区省—云南的129个县。目的:说明病人延误与病人到当地县级结核病(TB)中心的距离之间的关系。设计:对2005年登记的10 356例新涂阳结核病人的电子病历进行研究。结果:总延误的中位数是71 d(四分位数间距(IQR)为38～128),病人延误中位数为60 d(IQR为28～111),相对较短的医疗系统延误中位数为4 d(IQR为2～138)。农民和经济状况差的年长者(>40岁)与时间较长的病人延误明显相关。延误的风险随着地理距离的增加而增加,对相对较短的病人延误的影响更强。以距离的第一四分位数为对照组,短期病人延误(≤60 d)后续的四分位数的风险比分别为0.61(0.57～0.65),0.30(0.28～0.33)和0.15(0.14～0.17),长期病人延误(>60 d)后续的四分位数的风险比分别为1.04 (0.94～1.17),0.69(0.63～0.77)和0.43 (0.39～0.47)。结论:居住在边远地区的病人需要支持以克服地理距离带来的困难,这个困难对疾病早期影响更大。
Background: A mountainous province in China - 129 counties in Yunnan. Purpose: To illustrate the relationship between patient delay and patient’s distance from a local county TB center. Design: The electronic medical records of 10,365 new smear-positive TB patients registered in 2005 were studied. Results: The median total delay was 71 days (interquartile range (IQR) 38 to 128), the median patient delay was 60 days (IQR 28 to 111), and the relatively short delays in the medical system The median is 4 d (IQR is 2 ~ 138). Farmers and elderly with poor financial status (> 40 years) were significantly associated with delays in patients with longer durations. The risk of delay increases with geographic distance, with a greater impact on the shorter patient delays. Taking the first quartile of the distance as the control group, the risk ratios of the follow-up quartiles of short-term patients (≤60 days) were 0.61 (0.57-0.65), 0.30 (0.28-0.33) and 0.15 0.17, 0.69 (0.63-0.77) and 0.43 (0.39-0.47) for long-term patients with delayed (> 60 days) follow-up quartiles, respectively. Conclusions: Patients living in remote areas need support to overcome the difficulties associated with geographical distance, a difficulty that has a greater impact on the early stages of the disease.