title: The effect of geographical distance on TB patient delays in a mountainous province of China.
abstract: METHODS
  One hundred and twenty-nine counties in Yunnan, a mountainous province in China.
  
  
  OBJECTIVE
  To document the relationship between patient delays and distance to local county tuberculosis (TB) centres.
  
  
  METHODS
  A computerised medical record-based study of a cohort of 10356 new smear-positive TB cases in 2005.
  
  
  RESULTS
  The median total delay was 71 days (interquartile range [IQR] 38-128), with a median long patient delay of 60 days (IQR 28-111) and a relatively short median health care system delay of 4 days (IQR 2-13). Older age (>40 years), being an agriculturer and poor economic status were significantly associated with longer patient delays. Risk of delay increased with increasing geographical distance, with a greater effect on relatively shorter patient delays. Using the first quartile of distance as the reference group, hazard ratios for subsequent quartiles were 0.61 (0.57-0.65), 0.30 (0.28-0.33) and 0.15 (0.14-0.17) for short patient delays (<or=60 days), and 1.04 (0.94-1.17), 0.69 (0.63-0.77) and 0.43 (0.39-0.47) for long patient delays (>60 days).
  
  
  CONCLUSIONS
  Patients living in remote areas need support to overcome the barrier posed by geographical distance, which has a greater effect in the initial phases of the disease.
authors.affiliation: Yunnan Provincial Centers for Disease Control and Prevention, Yunnan, China. xulinth@hotmail.com
authors.forename: X
authors.initials: X
authors.lastname: Lin
authors.forename: V
authors.initials: V
authors.lastname: Chongsuvivatwong
authors.forename: A
authors.initials: A
authors.lastname: Geater
authors.forename: R
authors.initials: R
authors.lastname: Lijuan
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014195:Travel; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology