Cut-off Points of Treatment Delay to Predict Poor Outcomes Among New Pulmonary Tuberculosis Cases in Dalian, China: A Cohort Study

Abstract

Purpose: Despite increasing literature on the association between treatment delay and outcomes, cut-off point (1 month or median) selection in almost all studies for treatment delay is too subjective. This study explored more scientific cut-off points of treatment delay for poor treatment outcomes and death at the clinical level. Patients and Methods: A total of 18,100 newly confirmed pulmonary tuberculosis (TB) cases in Dalian, China were used in the final analysis. A 3-knotted restricted cubic spline (RCS) fitted for Cox proportional hazard regression models is used to analyse the effects of cut-off points of treatment delay on incident poor treatment outcomes. To explore the moderating effects of age, gender and diabetes, we added the interaction terms of these moderating variables and treatment delay to Cox proportional hazard regression models. Results:The median time of treatment initiation was 30 days (IQR: 14-59 days). The risk of incident poor treatment outcomes increased when the time was greater than cut-off point 1 (53 days; adjusted HR: 1.26; 95% CI: 1.00-1.60) of treatment delay, and the risk of incident death events increased when the time was greater than cut-off point 2 (103 days; adjusted HR: 1.56; 95% CI: 1.00-2.44) of delay. In addition, treatment delay was associated with an increased risk of incident poor treatment outcomes and death, and older age, male sex, and diabetes may increase the risk of treatment delay for poor outcomes. Conclusion:This study is the first to identify scientific cut-off points of treatment delay for poor treatment outcomes and death, and this method of exploration should be popularized. In addition, the knowledge of tuberculosis must be spread to every adult. Moreover, the tuberculosis diagnosis level of community level health workers should be enhanced.

Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal

“…Nevertheless, we also note that the obtained confidence intervals were quite wide, so it is possible that this study might not have had sufficient power. Further investigation in defining cut-offs for diagnosis delay is needed, as it is useful both for academic research and clinical practice [ 5 ]. Also, if patients were provided with an accurate cut-off from which they knew they should seek medical care regarding their symptoms, the patient delay period could decrease, assuming that timely access to healthcare is guaranteed [ 5 ].…”

“…This variable was dichotomised using a cut-off. The literature shows the most used cut-offs for patient delay are 21 and 30 days [ 5 , 30 ]. For this analysis’ purpose, we assumed that there was a considerable diagnostic delay when the patient delay was superior to 21 days.…”

“…As above mentioned, there is not a consensual cut-off defining the ideal timing of TB diagnosis, with the most used cut-off points for the patient delay in literature being 21 and 30 days [ 5 , 30 ]. Therefore, we also conducted a sensitivity analysis using the 30 days cut-off.…”

Drug Resistance Patterns and Trends in Patients with Suspected Drug-Resistant Tuberculosis in Dalian, China: A Retrospective Study

“… 15 The incidence of TB in the region is 52/100,000, which is well above the global average. 16 However, the Directly Observed Treatment and Short Course (DOTS) strategy and the Global Fund for MDR-TB Prevention and Treatment project have been implemented in this region since 2012. 15 Many patients with suspected DR-TB are diagnosed in Dalian every year, and these patients can easily develop MDR-TB or even XDR-TB.…”