title: Delays in the diagnosis of pulmonary tuberculosis in Coahuila, Mexico.
abstract: OBJECTIVE
  To determine diagnostic delay in pulmonary tuberculosis (PTB) cases and analyse associated factors.
  
  
  METHODS
  New PTB cases were studied in Coahuila, Northern Mexico, between 2008 and 2009. We obtained census data and data on residential address, symptoms and diagnosis  from the national patient database; sociodemographic variables were obtained during home visits. Bivariate analyses used the Kaplan-Meier method; multivariate analysis consisted of modelling survival.
  
  
  RESULTS
  We studied 458 subjects (median age 48 years), who were predominantly males (56.1%);  the median years of schooling was 6.0 years, 83.4% were urban residents, 50.3% were unemployed, and 87.7% suffered from food poverty. The median delay between the onset of symptoms and the first medical consultation was 53.5 days. Lack of formal education (P = 0.050) and living ≥5  km from a health unit (P = 0.034) were associated with longer delays and consequently with severe symptoms (cough ≥2 weeks, P = 0.001; chest pain, P = 0.032; malnutrition, P = 0.003). Mean health system delay (between first consultation and smear test result)  was 18.5 days, and was significantly longer when the first consultation was with a private physician (P < 0.001) and when patient age was ≥46 years (P = 0.001).
  
  
  CONCLUSIONS
  In Coahuila, lack of formal education, living ≥5 km from a health unit, first consultation  with a private physician, and being aged ≥46 years contributed to delays in PTB diagnosis.
authors: Instituto Mexicano del Seguro Social, Delegación Coahuila, Secretaria de Salud de Coahuila and Grups de  Recerca d'America, Saltillo, México.
authors: J
authors: J
authors: Salinas
authors: S
authors: S
authors: Calvillo
authors: J
authors: J
authors: Caylà
authors: F B
authors: FB
authors: Nedel
authors: M
authors: M
authors: Martín
authors: A
authors: A
authors: Navarro
mesh_terms: D000328:Adult; D000367:Age Factors; D000995:Antitubercular Agents / Q000627:therapeutic use; D057210:Delayed Diagnosis; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011331:Private Practice; D012017:Referral and Consultation; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality
chemical_list: D000995:Antitubercular Agents