Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France.
OBJECTIVE
To analyse diagnostic delay in tuberculosis (TB) patients.


METHODS
Cross-sectional study: all patients with TB notified to the French national surveillance system from April to June 2010 were interviewed face-to-face using a standardised questionnaire to assess symptom  history and health-seeking trajectories.


RESULTS
Of 225 patients enrolled, 172 (76.4%) had pulmonary TB, including 88 who were smear-positive. Mean delay between first symptoms and diagnosis (total delay) was 97 days (median 68, IQR 33-111), with a mean of 47 days (median 14, IQR  0-53) between first symptoms and health care contact (patient delay), and 48 days (median 25, IQR 6-67) between health care contact and diagnosis (health system delay). Factors independently associated with shortened total delay were medical insurance (OR 0.24, P = 0.014)  and previous TB (OR 0.28, P = 0.049). Those associated with reduced patient delay were initial fever (OR 0.42, P = 0.03) and being followed by a general practitioner (OR 0.22, P = 0.004), while those associated with reduced health system delay were first health care contact  within a hospital (OR 0.15, P < 0.001). Empirical antibiotic treatment was associated with increased health system delay (OR 4.4, P = 0.001).


CONCLUSIONS
TB diagnostic delay needs to be reduced in France. This may be achieved through improved access to care, earlier hospital  referral, and less use of empirical antibiotic treatment.
Unité des Maladies Infectieuses et Réanimation Médicale, CHU Pontchaillou, Rennes, France. pierre.tattevin@chu-rennes.fr
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D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D005602:France; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012017:Referral and Consultation; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis; D055815:Young Adult
D000900:Anti-Bacterial Agents