title: Determinants of health system delay among confirmed tuberculosis cases in Spain.
abstract: BACKGROUND
  Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients.
  
  
  METHODS
  Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables.
  
  
  RESULTS
  A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged.
  
  
  CONCLUSIONS
  Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.
authors: TB Research Unit, National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain. mdiez@isciii.es
authors: M
authors: M
authors: Díez
authors: M J
authors: MJ
authors: Bleda
authors: J
authors: J
authors: Alcaide
authors: C
authors: C
authors: Castells
authors: J I
authors: JI
authors: Cardenal
authors: A
authors: A
authors: Domínguez
authors: P
authors: P
authors: Gayoso
authors: G
authors: G
authors: Guitiérrez
authors: C
authors: C
authors: Huerta
authors: M J
authors: MJ
authors: López
authors: T
authors: T
authors: Moreno
authors: F
authors: F
authors: Muñoz
authors: A
authors: A
authors: García-Fulgueiras
authors: M
authors: M
authors: Picó
authors: F
authors: F
authors: Pozo
authors: J R
authors: JR
authors: Quirós
authors: F
authors: F
authors: Robles
authors: J M
authors: JM
authors: Sánchez
authors: H
authors: H
authors: Vanaclocha
authors: T
authors: T
authors: Vega
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D015980:Public Health Practice; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000628:therapy*