Abstract
BackgroundTuberculosis (TB) continues to be a major public health challenge in China. Understanding TB management delays within the context of China’s unique ethnic diversity may be of value in tackling the disease. This study sought to evaluate the impact of ethnic minority status on TB diagnosis and treatment delays.MethodsThis retrospective cohort study was conducted on patients diagnosed with TB in Hunan Province, China between 2013 and 2018. Diagnosis delay was defined as the time interval between the onset of symptoms and the date of diagnosis. Treatment delay was defined as the time interval between diagnosis and treatment commencement. Univariable and multivariable logistic regression models were used to identify factors associated with TB diagnosis and treatment delay, including ethnic minority status. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to assess the strength of association between the dependant and independent variables.ResultsA total of 318,792 TB patients were included in the study with a mean age of 51.7 years (SD 17.7). The majority of patients were male (72.6%) and Han ethnicity (90.6%). The odds of experiencing diagnosis delay (> 21 days) were significantly higher for Tujia (AOR: 1.46, 95% CI: 1.41, 1.51), Miao (AOR: 1.31, 95% CI: 1.26, 1.37), Dong (AOR: 1.97, 95% CI: 1.85, 2.11), Yao (AOR: 1.27, 95% CI: 1.17, 1.37), and Bai (AOR: 1.45, 95% CI: 1.22, 1.74) ethnic minorities compared to the Han majority. The odds of experiencing treatment delay (> 15 days) were significantly lower for five of the seven ethnic minority groups relative to the Han majority: Tujia (AOR 0.92, 95% CI 0.88, 0.96), Miao (AOR 0.74, 95% CI 0.70, 0.79), Dong (AOR 0.87, 95% CI 0.81, 0.95), Yao (AOR 0.20, 95% CI 0.17, 0.24) and ‘other’ (ethnic minorities that individually represented < 0.1% of the patient population) (AOR 0.70, 955 CI 0.51, 0.97).ConclusionsThis study shows ethnic minority status to be a significant risk factor in diagnosis delay, but for it to reduce the odds of treatment delay. Further research is required to determine the underlying causes of diagnosis delay within ethnic minority populations.
Highlights
Tuberculosis (TB) continues to be a major public health challenge in China
Patients who reside in local counties Patients who reside in other counties within the province Patients who reside in provinces other than Hunan Patients who reside in other countries
M.tuberculosis that is susceptible to first line antibiotics M.tuberculosis that is resistant to isoniazid and rifampicin M.tuberculosis resistant to a single first line antibiotic
Summary
Tuberculosis (TB) continues to be a major public health challenge in China. This study sought to evaluate the impact of ethnic minority status on TB diagnosis and treatment delays. Tuberculosis (TB) is currently second to Coronavirus Disease 2019 (COVID -19) as a leading cause of death from a single infectious agent [1], claiming a life every 22 s [2]. Prior to the COVID-19 pandemic, TB was the leading cause of death [3] and throughout history is thought to have claimed more lives than any other microorganism [4]. In 1991, China launched its National Tuberculosis Control Programme (NTP) based on the World Health Organization (WHO) recommended Directly Observed Treatment Short-course (DOTS) strategy. The NTP aims to provide TB diagnosis and treatment services free of charge, with a focus on the poor, ethnic minorities and other vulnerable population groups. The NTP aims to provide TB diagnosis and treatment services free of charge, with a focus on the poor, ethnic minorities and other vulnerable population groups. [9, 10]
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