The effect of geographical distance on TB patient delays in a mountainous province of China

X Lin, V Chongsuvivatwong, A Geater, R Lijuan
International Journal of Tuberculosis and Lung Disease 2008, 12 (3): 288-93

SETTING: 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.

DESIGN: 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).

CONCLUSION: 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.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"