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Gender and time delays in diagnosis of pulmonary tuberculosis: a cross-sectional study from China

  • H. G. Chen (a1), T. W. Wang (a2) and Q. X. Cheng (a2)

Abstract

Gender inequality has severe consequences on public health in terms of delay in diagnosis of pulmonary tuberculosis (PTB). In order to explore gender-related differences in diagnosis delay, a cross-sectional study of 10 686 patients diagnosed with PTB in Yulin from 1 January 2009 to 31 December 2014 was conducted. Diagnosis delay was categorised into ‘short delay’ and ‘long delay’ by four commonly used cut-off points of 14, 30, 60 and 90 days. Logistic regression analysis was used to analyse gender differences in diagnostic delay. Stratified analyses by smear results, age, urban/rural were performed to examine whether the effect persisted across the strata. The median delay was 31 days (interquartile range 13–65). Diagnostic delay in females at cut-off points of 14, 30, 60 and 90 days had odds ratios (OR) of 0.99 (95% CI 0.91–1.09), 1.09 (95% CI 1.01–1.18), 1.15 (95% CI 1.05–1.26) and 1.18 (95% CI 1.06–1.31), respectively, compared with males. Stratified analysis showed that females were associated with increased risk of longer delay among those aged 30–60 years, smear positive and living in the rural areas (P < 0.05). The female-to-male OR increased along with increased delay time. Further inquiry into the underlying reasons for gender differences should be urgently addressed to improve the current situation.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: H. G. Chen, E-mail: hgchen38@gmail.com

References

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1.World Health Organization (2012) Global tuberculosis report. http://apps.who.int/iris/bitstream/10665/75938/1/9789241564502_eng.pdf.
2.Jia, Z, Cheng, S and Wang, L (2012) Tuberculosis control in China: striving for sustainability. Lancet 379, 2149.
3.Sharma, A et al. (2017) Estimating the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in India, the Philippines, Russia, and South Africa: a mathematical modelling study. Lancet Infectious Diseases 17, 707715.
4.Blondal, K (2007) Barriers to reaching the targets for tuberculosis control: multidrug-resistant tuberculosis. Bulletin of the World Health Organization 85, 387390, discussion 391-384.
5.Donald, PR and van Helden, PD (2009) The global burden of tuberculosis – combating drug resistance in difficult times. New England Journal of Medicine 360, 23932395.
6.Li, Y et al. (2013) Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis. BMC Medicine 11, 156.
7.Keshavjee, S, Dowdy, D and Swaminathan, S (2015) Stopping the body count: a comprehensive approach to move towards zero tuberculosis deaths. Lancet 386, e46e47.
8.Fujiwara, PI and Dlodlo, RA (2016) Tuberculosis control. Lancet 387, 11581159.
9.World Health Organization (2011) Early Detection of Tuberculosis: An Overview of Approaches, Guidelines and Tools. WHO Document: WHO/HTM/STB/PSI/2011.21. Geneva: World Health Organization, https://extranet.who.int/iris/restricted/bitstream/10665/70824/1/WHO_HTM_STB_PSI_2011.21_eng.pdf.
10.Yimer, S, Bjune, G and Alene, G (2005) Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infectious Diseases 5, 112.
11.Virenfeldt, J et al. (2014) Treatment delay affects clinical severity of tuberculosis: a longitudinal cohort study. BMJ Open 4, e004818.
12.Ettehad, D et al. (2012) Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis. Lancet Infectious Diseases 12, 449456.
13.Feng, JY et al. (2012) Gender differences in treatment outcomes of tuberculosis patients in Taiwan: a prospective observational study. Clinical Microbiology and Infection 18, E331E337.
14.Diwan, VK and Thorson, A (1999) Sex, gender, and tuberculosis. Lancet 353, 10001001.
15.Loto, OM and Awowole, I (2012) Tuberculosis in pregnancy: a review. Journal of Pregnancy 2012, 379271.
16.Weiss, MG, Sommerfeld, J and Uplekar, MW (2008) Social and cultural dimensions of gender and tuberculosis. International Journal of Tuberculosis and Lung Disease 12, 829830.
17.WHO (2004) Gender and Tuberculosis, Gender and Health Research Series. Geneva: WHO.
18.Wang, J et al. (2008) Gender difference in knowledge of tuberculosis and associated health-care seeking behaviors: a cross-sectional study in a rural area of China. BMC Public Health 8, 354.
19.Chen, M et al. (2014) Gender and regional disparities of tuberculosis in Hunan, China. International Journal for Equity in Health 13, 32.
20.Gebreegziabher, SB, Bjune, GA and Yimer, SA (2016) Patients’ and health system's delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study. BMC Infectious Diseases 16, 673.
21.Storla, DG et al. (2008) A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health 8, 15.
22.Rajeswari, R et al. (2002) Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India. International Journal of Tuberculosis and Lung Disease 6, 789795.
23.Kiwuwa, MS et al. (2005) Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study. Bmc Public Health 5, 122.
24.Yang, WT et al. (2014) Barriers and delays in tuberculosis diagnosis and treatment services: does gender matter? Tuberculosis Research and Treatment 2014, 461935.
25.Mathad, JS and Gupta, A (2012) Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps. Clinical Infectious Diseases 55, 15321549.
26.Needham, DM et al. (2001) Socio-economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia. Tropical Medicine & International Health 6, 256259.
27.Lambert, ML et al. (2005) Delays to treatment and out-of-pocket medical expenditure for tuberculosis patients, in an urban area of South America. Annals of Tropical Medicine and Parasitology 99, 781787.
28.Cheng, G et al. (2005) Factors affecting delays in tuberculosis diagnosis in rural China: a case study in four counties in Shandong Province. Transactions of the Royal Society of Tropical Medicine and Hygiene 99, 355362.
29.Yamasaki-Nakagawa, M et al. (2001) Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. The International Journal of Tuberculosis and Lung Disease 5, 2431.
30.Karim, F et al. (2007) Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy and Planning 22, 329334.

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