Variables associated with diagnostic delay in immigrant groups with tuberculosis in Madrid.
OBJECTIVE
To identify variables associated with total diagnostic delay (TDD), patient delay (PD) and health service delay (HSD), among the tuberculous immigrant population in the Autonomous Community of Madrid (ACT).


METHODS
Tuberculosis cases diagnosed in 15 hospitals in the ACT in 2003 were interviewed face-to-face and medical records were reviewed. A descriptive study was conducted, followed by univariate and multivariate analysis using non-conditional logistic regressions. 50th (p50) and 75th (p75) percentiles of the different diagnostic delay components were analysed as dependent variables.


RESULTS
For the 296 cases included, the mean TDD was 40.5 days (IQR 16.0-90.0), the PD was 15 days (IQR 6.5-30.0), and the HSD was 5 days (IQR 0.0-30.0). TDD-p75 is associated with seeking primary health care (OR 2.87, 95%CI 1.47-5.58). PD-p75 is associated with identification of fever (OR 0.49, 95%CI 0.25-0.92) and non-identification of cough (OR 1.87, 95%CI 1.05-3.36) as symptoms resulting in health care being sought. The HSD-p75 is associated with primary health care being sought (OR 3.81, 95%CI 1.87-7.78), health cover (OR 15.07, 95%CI 1.96-115.68) and negative smear results at the time of diagnosis (OR 1.98, 95%CI 1.01-3.91).


CONCLUSIONS
The HSD needs to be reduced, mainly when health care is sought through the primary care services and among patients with negative smear results.
Sanz
B
B
National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain. bsanz@isciii.es
Blasco
T
T
D003371:Cough / Q000209:etiology; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000209:etiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D014504:Urban Health / Q000706:statistics & numerical data