title: Factors associated with delayed diagnosis of pulmonary tuberculosis in the state of Rio de Janeiro, Brazil.
abstract: OBJECTIVE
  To estimate the total time elapsed between symptom onset and diagnosis of pulmonary tuberculosis (patient delay plus health care system delay), analyzing the factors associated with delayed diagnosis in the state of Rio de Janeiro, Brazil.
  
  
  METHODS
  We conducted a questionnaire-based survey involving 218 pulmonary tuberculosis patients treated for two months at 20 health care clinics and 3 hospitals in eight cities within the state of Rio de Janeiro. We collected socioeconomic and demographic data, as well as data regarding the health care system and the medical history of the patients.
  
  
  RESULTS
  The median time elapsed from the onset of symptoms to diagnosis was 68 days (interquartile range [IQR]: 35-119 days). The median patient delay (time from symptom onset to initial medical visit) was 30 days (IQR: 15-60 days), and the median health care system delay (time from initial medical visit to diagnosis) was 21 days (IQR: 8-47 days). A cut-off point of 21 days was adopted. The factors independently associated with patient delay were female gender, cough, and unemployment [adjusted OR (95% CI) = 2.7 (1.3-5.6); 11.6 (2.3-58.8); and 2.0 (1.0-3.8), respectively], whereas only female gender was independently associated with health care system delay (OR= 3.2; 95% CI: 1.7-6.0).
  
  
  CONCLUSIONS
  Delayed diagnosis of pulmonary tuberculosis remains a problem in Rio de Janeiro, increasing the risk of transmission and mortality, that risk being greater for women and the socioeconomically disadvantaged. Patients might not recognize the significance of chronic cough as a health problem. Tuberculosis education programs targeting women might improve this situation.
authors: Federal University of Rio de Janeiro, RJ, Brasil. audrycftm@gmail.com
authors: Audry Cristina de Fátima Teixeira
authors: AC
authors: Machado
authors: Ricardo Ewbank
authors: RE
authors: Steffen
authors: Olivia
authors: O
authors: Oxlade
authors: Dick
authors: D
authors: Menzies
authors: Afrânio
authors: A
authors: Kritski
authors: Anete
authors: A
authors: Trajman
mesh_terms: D000328:Adult; D001938:Brazil; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000517:prevention & control