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Zhang L, Ma X, Gao H, Bao C, Wu Y, Wu S, Liu M, Liu Y, Li L. Analysis of care-seeking and diagnosis delay among pulmonary tuberculosis patients in Beijing, China. Front Public Health 2024; 12:1369541. [PMID: 38689776 PMCID: PMC11058192 DOI: 10.3389/fpubh.2024.1369541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
Background Tuberculosis (TB) remains a significant public health challenge in China. Early detection and diagnosis of TB cases are crucial to interrupt disease transmission and prevent its progression. This study aims to describe the delay in seeking care and diagnosis among patients with pulmonary tuberculosis (PTB) and identify the influencing factors in two counties in Beijing. Methods A retrospective analysis was carried out to investigate care-seeking and diagnosis delay in two counties in Beijing. Basic information of PTB patients from January 1 to December 31, 2021, was extracted from the Tuberculosis Information Management System of China (TBIMS), and all enrolled patients were interviewed via telephone using a standard questionnaire. Statistical description was performed using the median and interquartile range (IQR). Chi-square test and multivariate logistic regression model were used to analyze the influencing factors. Results 537 patients were enrolled. The median duration of care-seeking and diagnosis delay was 11 (IQR: 5-26) days and 8 (IQR: 0-18) days, with 41.71 and 35.20% of patients experiencing delays (>14 days). The study found that being asymptomatic (OR = 2.791, 95%CI: 1.710-4.555) before seeking medical care and not attending work during treatment (OR = 2.990, 95%CI: 1.419-6.298) were identified as risk factors for care-seeking delay. Patients who were tracked (OR = 2.632, 95%CI: 1.062-6.521) and diagnosed at tuberculosis control and prevention institutions (OR = 1.843, 95%CI: 1.061-3.202) had higher odds of diagnostic delays. 44.69% of patients presented a total delay (>28 days), with a median duration of 25 (IQR: 13-39) days. A multivariate logistic regression analysis showed that healthy examination (OR = 0.136, 95%CI: 0.043-0.425) was a protective factor for total delay. Conclusion Public interventions are necessary to improve the efficiency of PTB patients detection and treatment in Beijing. Medical services should focus on the target population and improve access to medical care to further reduce delays for PTB patients.
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Affiliation(s)
- Lijie Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing, China
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Clinical Center on Tuberculosis, China CDC, Beijing, China
| | - Xiaoge Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hanqing Gao
- Institute of Tuberculosis Prevention and Control, Tongzhou District Center for Disease Prevention and Control, Beijing, China
| | - Cheng Bao
- Beijing Changping Institute for Tuberculosis Prevention and Treatment, Beijing, China
| | - Yue Wu
- Institute of Tuberculosis Prevention and Control, Tongzhou District Center for Disease Prevention and Control, Beijing, China
| | - Sihui Wu
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Menghan Liu
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yuhong Liu
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Clinical Center on Tuberculosis, China CDC, Beijing, China
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Li
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Clinical Center on Tuberculosis, China CDC, Beijing, China
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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Ge R, Zhu G, Tian M, Hou Z, Pan W, Feng H, Liu K, Xiao Q, Chen Z. Analysis on time delay of tuberculosis among adolescents and young adults in Eastern China. Front Public Health 2024; 12:1376404. [PMID: 38651131 PMCID: PMC11033351 DOI: 10.3389/fpubh.2024.1376404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Background Tuberculosis (TB) is recognized as a significant global public health concern. Still, there remains a dearth of comprehensive evaluation regarding the specific indicators and their influencing factors of delay for adolescents and young adults. Methods All notified pulmonary TB (PTB) patients in Jiaxing City were collected between 2005 and 2022 from China's TB Information Management System. Logistic regression models were conducted to ascertain the factors that influenced patient and health system delays for PTB cases, respectively. Furthermore, the impact of the COVID-19 pandemic on local delays has been explored. Results From January 1, 2005 to December 31, 2022, a total of 5,282 PTB cases were notified in Jiaxing City, including 1,678 adolescents and 3,604 young adults. For patient delay, female (AOR: 1.18, 95%CI: 1.05-1.32), PTB complicated with extra-pulmonary TB (AOR: 1.70, 95% CI: 1.28-2.26), passive case finding (AOR: 1.46, 95% CI: 1.07-1.98) and retreatment (AOR: 1.52, 95% CI: 1.11-2.09) showed a higher risk of delay. For health system delay, minorities (AOR: 0.69, 95% CI: 0.53-0.90) and non-students (AOR: 0.83, 95% CI: 0.71-0.98) experienced a lower delay. Referral (AOR: 1.46, 95% CI: 1.29-1.65) had a higher health system delay compared with clinical consultation. Furthermore, county hospitals (AOR: 1.47, 95% CI: 1.32-1.65) and etiological positive results (AOR: 1.46, 95% CI: 1.30-1.63) were associated with comparatively high odds of patient delay. Contrarily, county hospitals (AOR: 0.88, 95% CI: 0.78-1.00) and etiological positive results (AOR: 0.67, 95% CI: 0.59-0.74) experienced a lower health system delay. Besides, the median of patient delay, health system delay, and total delay during the COVID-19 pandemic were significantly lower than that before. Conclusion In general, there has been a noteworthy decline in the notification rate of PTB among adolescents and young adults in Jiaxing City while the declining trend was not obvious in patient delay, health system delay, and total delay, respectively. It also found factors such as gender, case-finding method, and the hospital level might influence the times of seeking health care and diagnosis in health agencies. These findings will provide valuable insights for refining preventive and treatment strategies for TB among adolescents and young adults.
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Affiliation(s)
- Rui Ge
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Guoying Zhu
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Min Tian
- Nanhu Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Zhigang Hou
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Weizhe Pan
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Hao Feng
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qinfeng Xiao
- The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Zhongwen Chen
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
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Huang S, Kang X, Zeng Z, Zhang Q, Huang Z, Luo K, Yao Q, Chen B, Qing C. Neutrophil lncRNA ZNF100-6:2 is a potential diagnostic marker for active pulmonary tuberculosis. Eur J Med Res 2024; 29:162. [PMID: 38475909 DOI: 10.1186/s40001-024-01755-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Active pulmonary tuberculosis (PTB) poses challenges in rapid diagnosis within complex clinical conditions. Given the close association between neutrophils and tuberculosis, we explored differentially expressed long non-coding RNAs (lncRNAs) in neutrophils as potential molecular markers for diagnosing active PTB. We employed a gene microarray to screen for lncRNA alterations in neutrophil samples from three patients with active PTB and three healthy controls. The results revealed differential expression of 1457 lncRNAs between the two groups, with 916 lncRNAs upregulated and 541 lncRNAs down-regulated in tuberculosis patients. Subsequent validation tests demonstrated down-regulation of lncRNA ZNF100-6:2 in patients with active PTB, which was restored following anti-tuberculosis treatment. Our findings further indicated a high diagnostic potential for lncRNA ZNF100-6:2, as evidenced by an area under the receiver operating characteristic (ROC) curve of 0.9796 (95% confidence interval: 0.9479 to 1.000; P < 0.0001). This study proposes lncRNA ZNF100-6:2 as a promising and novel diagnostic biomarker for active PTB.
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Affiliation(s)
- Shuying Huang
- Department of Reproductive Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Xiuhua Kang
- Infection Control Department of the First Affiliated Hospital of Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
- Major Public Health Medical Center of Jiangxi Province, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Zhenguo Zeng
- Department of Intensive Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
- Key Laboratory of Critical Care Medicine, Jiangxi Provincial Health Commission, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Qilong Zhang
- Department of Neurology, Chest Hospital of Jiangxi Province, Nanchang, 330006, China
| | - Zikun Huang
- Nanchang Key Laboratory of Diagnosis of Infectious Diseases, Nanchang, China
- Department of Clinical Laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Kaihang Luo
- Department of Intensive Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Qinqin Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Bing Chen
- Department of Infection, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Cheng Qing
- Department of Intensive Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China.
- Key Laboratory of Critical Care Medicine, Jiangxi Provincial Health Commission, 17 Yongwai Zhengjie, Nanchang, 330000, China.
- Nanchang Key Laboratory of Diagnosis of Infectious Diseases, Nanchang, China.
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Chen X, Zhou J, Yuan Q, Zhang R, Huang C, Li Y. Challenge of ending TB in China: tuberculosis control in primary healthcare sectors under integrated TB control model-a systematic review and meta-analysis. BMC Public Health 2024; 24:163. [PMID: 38212753 PMCID: PMC10785344 DOI: 10.1186/s12889-023-16292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/11/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND China has the third-largest burden of tuberculosis (TB) cases in the world with great challenges towards ending TB. Primary health care (PHC) sectors play a critical role in TB prevention and control in communities under the Chinese integrated TB control model. However, there is a lack of comprehensive review of research evidence on TB control in PHC sectors under the integrated TB control model in China. METHODS This review was conducted following the PRISMA guidelines. Articles published from 2012 to January 2022 were searched from four international and three Chinese databases. Studies conducted inside mainland China and relevant with TB control service in PHC sectors under the integrated model were included. After study selection, data extraction, and quality assessment, the meta-analysis was performed with RevMan using a random-effect model.When I2 was more than 50%, subgroup analysis was performed to explore possible reasons for heterogeneity. We also conducted a post hoc sensitivity analysis for outcomes after meta-analysis by exclusion of studies with a high risk of bias or classified as low quality. RESULTS Forty-three studies from 16 provinces/municipalities in China were included in this review, and most studies included were of medium quality. PHC sectors in East China delivered TB control service better overall than that in West China, especially in tracing of patients and TB case management (TCM). In meta-analyses, both the pooled arrival rate of tracing and pooled TCM rate in East China were higher than those in West China. TB patients had a low degree of willingness to receive TCM provided by healthcare workers in PHC sectors nationwide, especially among migrant TB patients. There were 9 studies reporting factors related to TB control service in PHC sectors, 6 (2 in East and 4 in West China) of which indentified several characteristics of patients as associated factors. The context of PHC sectors was demonstrated to influence delivery of TB control service in PHC sectors in 5 studies (3 in East, 1 in Middle and 1 in West China). Most studies on strategies to promoting TB control services in PHC sectors were conducted in East China and some of these studies identified several online and offline interventions and strategies improving patients' treatment compliance [pooled OR (95% CI): 7.81 (3.08, 19.19] and awareness of TB [pooled OR (95% CI): 6.86 (2.16, 21.72)]. CONCLUSION It is of urgent need to improve TB control in PHC sector in China, particularly in West China. Formative and implementation research with rigorous design are necessary to develop comprehensive, context-specific, and patient-centered TB control strategies to promote ending TB in China.
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Affiliation(s)
- Xi Chen
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
- Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Quan Yuan
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Chunji Huang
- Army Medical University (Third Military Medical University), Chongqing, China.
| | - Ying Li
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China.
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Li T, Du X, Kang J, Luo D, Liu X, Zhao Y. Patient, Diagnosis, and Treatment Delays Among Tuberculosis Patients Before and During COVID-19 Epidemic - China, 2018-2022. China CDC Wkly 2023; 5:259-265. [PMID: 37138894 PMCID: PMC10150750 DOI: 10.46234/ccdcw2023.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
What is already known about this topic? The coronavirus disease (COVID-19) pandemic could have a damaging impact on access to tuberculosis (TB) diagnosis and treatment. What is added by this report? The overall delay experienced by TB patients during the COVID-19 pandemic has shown a modest decrease in comparison to the period before the pandemic. Notably, higher patient delays were observed among agricultural workers and those identified through passive case-finding methods. Furthermore, the patient delay in eastern regions was shorter compared to western and central regions. What are the implications for public health practice? The observed increase in patient delay in 2022 should be of concern for ongoing TB control efforts. Health education and active screening initiatives must be enhanced and broadened among high-risk populations and regions characterized by extended patient delays.
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Affiliation(s)
- Tao Li
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Xin Du
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Jiaojie Kang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Dan Luo
- Department of Public Health, Hangzhou Medical College, Hangzhou City, Zhejiang Province, China
| | - Xiaoqiu Liu
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
- Yanlin Zhao,
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