title: Patient and health care system delays in pulmonary tuberculosis diagnosis in a low-incidence state.
abstract: METHODS
  Tuberculosis (TB) patients reported to the Maryland Department of Health and Mental Hygiene from 1 June 2000 to 30 November 2001.
  
  
  OBJECTIVE
  To determine the extent of delayed diagnosis of TB and to assess patient and provider factors associated with delays.
  
  
  METHODS
  A prospective cohort study.
  
  
  RESULTS
  Median patient, health care and total delays were 32, 26 and 89 days, respectively, for 158 patients. Non-white (relative hazard [RH] 0.62; 95% CI 0.39-0.98) and less educated (RH 0.43; 95% CI 0.26-0.72) patients had longer patient delays. English-speaking patients (RH 0.40; 95% CI 0.24-0.68) had increased health care delays, as did patients who received a diagnosis of a respiratory illness and non-TB antibiotics (RH 0.69; 95% CI 0.49-0.96) prior to a TB diagnosis. Patients first presenting to a private physician (51 days) rather than a hospital emergency room (18 days; RH 1.87; 95% CI 1.05-3.33) or public health clinic (10 days; RH 1.79; 95% CI 1.21-2.63) had longer health care delays. When a TB diagnostic tool (chest radiograph or AFB culture) was utilized, a more rapid diagnosis of TB was made.
  
  
  CONCLUSIONS
  Education of the patient population about TB symptoms might reduce delays. Increased physician awareness of the current epidemiology of TB and better use of available diagnostic tools will reduce delays and may reduce TB transmission.
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, Maryland 21231, USA. jgolub@jhmi.edu
authors.forename: J E
authors.initials: JE
authors.lastname: Golub
authors.forename: S
authors.initials: S
authors.lastname: Bur
authors.forename: W A
authors.initials: WA
authors.lastname: Cronin
authors.forename: S
authors.initials: S
authors.lastname: Gange
authors.forename: N
authors.initials: N
authors.lastname: Baruch
authors.forename: G W
authors.initials: GW
authors.lastname: Comstock
authors.forename: R E
authors.initials: RE
authors.lastname: Chaisson
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*