Delayed diagnosis of tuberculosis: risk factors and effect on mortality among older adults in Hong Kong

Leung, Eric Chung Ching; Leung, Chi Chiu; Chang, Kwok Chiu; Chan, Chi Kuen; Mok, Thomas; Chan, K. S.; Lau, Kam Shing; Chau, CH; Yee, Wilson K.S.; Law, Wing Sze; Lee, S N; Au, Ka-wing; Tai, Lai Bun; Leung, WM

doi:10.12809/hkmj177081

Cited by 13 publications

(11 citation statements)

References 20 publications

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“…Most of them were old-aged patients with multiple morbidities, and delayed diagnosis ranged from 22 to 104 days. Because these patients initially visited the hospital because of other acute illnesses, our analysis of the post-mortem patients showed a low suspicion of TB disease and smear negativity, similar to the findings of a previous study (24).…”

Section: Discussionsupporting

confidence: 86%

Clinical profiles and outcomes of pulmonary tuberculosis patients with delayed treatment at a tertiary hospital in South Korea

Kim¹,

Min²,

Cho³

et al. 2021

Ann Palliat Med

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Background: Data on the clinical characteristics of delayed treatment initiation among pulmonary tuberculosis (TB) patients are lacking. Thus, this study aimed to identify the factors associated with delayed treatment in culture-confirmed pulmonary TB and to assess outcomes of delayed treatment.Methods: We retrospectively evaluated 151 patients with culture-confirmed pulmonary TB between 2015 and 2017. Delayed and timely treatment was defined as initiation of anti-TB treatment after and before the identification of Mycobacterium tuberculosis complex isolate, respectively. Factors related to delayed treatment, such as comorbidities, clinical presentation, and patterns of initial healthcare use, were collected.We analyzed whether delayed treatment was associated with all-cause mortality using a multivariate binary logistic regression model adjusted for age, sex, cardiovascular disease, and malignancy.Results: In total, 55 (36.4%) patients had delayed treatment. The median length between the first medical visit and treatment initiation was 9 days. Compared with timely treatment, delayed treatment was associated with no initial visit to a non-pulmonary department [adjusted odds ratio (aOR) =10.49, 95% confidence interval (CI), 2.56-42.93] and absence of nucleic acid amplification test (aOR =7.54, 95% CI, 2.75-20.67).After adjusting for age, sex, cardiovascular disease, and solid malignancies, delayed treatment was significantly associated with all-cause mortality (aOR =3.79, 95% CI, 1.36-10.58). The most frequent possible cause of delayed treatment was the doctor's low suspicion of active TB disease.Conclusions: Given that delayed treatment is associated with worse outcomes in South Korea, targeted interventions to increase awareness on TB in the healthcare community are necessary for additional mycobacterial tests and consults of suspicious patients to TB specialists.

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Section: Discussionsupporting

confidence: 86%

Clinical profiles and outcomes of pulmonary tuberculosis patients with delayed treatment at a tertiary hospital in South Korea

Kim¹,

Min²,

Cho³

et al. 2021

Ann Palliat Med

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“…Some surveys have reported the status of and factors associated with delayed treatment in patients with different diseases, especially cancers and infectious diseases ( Saver et al, 2016 ; Getnet et al, 2017 ; de Haan et al, 2018 ; Leung et al, 2018 ; Vizza et al, 2018 ). However, the status of delayed diagnosis and treatment in elderly patients has not received much attention and warrants greater concern.…”

Section: Discussionmentioning

confidence: 99%

Delays in Seeking Medical Services in Elderly Patients With Senile Cataract

et al. 2022

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Delay in seeking medical services is common in elderly populations, which leads to disease progression and life difficulty. This study aims to assess the prevalence of delay in medical visits and treatment and define associated effects and factors in patients with senile cataract, which may help obtain a better understanding of late-life psychopathology and provide the basis for interventions. Patients aged more than 60 years were prospectively recruited in Zhongshan Ophthalmic Center (ZOC). All participants were diagnosed with binocular senile cataract and decided to have primary surgery in ZOC. The distributions of the popularity of delaying outpatient visits and treatment, the degrees of visual impairment, the influences on quality of life, and the reasons for delaying treatment among participants were accessed by the descriptive statistics. Factors associated with the perceptions of cataract treatment were accessed using a binary logistic regression model. A total of 400 senile patients aged from 60 to 94 years were enrolled. At diagnosis, 82 (20.5%) participants had a low vision with monocular acuity of both eyes below 0.05. All participants have felt that their normal lives were affected, and 64 (16%) participants felt that their lives were affected severely. Only 17 (4.25%) participants have sought for medical services immediately after feeling vision loss, and 294 (73.50%) participants have felt vision loss since a year ago before seeking medical help. A total of 298 (74.50%) participants have delayed the surgery time, and 229 (57.25%) patients delayed it for more than 12 months. There were 147 (36.75%) participants delaying surgery on account of no knowledge about it and 114 (28.50%) participants delaying surgery because of fear. There are a high proportion of elderly patients with senile cataract delaying their outpatient visits and surgery treatment, whose normal lives were severely affected. Increasing medical service propaganda about cataract and other common diseases in elderly populations would probably be helpful for improving perceptions of diseases and decreasing medical delays. Public needs to draw more attention to the healthy and medical status of the elderly ocular patients.

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“…In Nepal, the median patient delay was 50 days, the median health system-related delay was 18 days, and the median total diagnosis delay was 60 days [ 17 ]. In Hong Kong, the risk of mortality is associated with delayed diagnosis in elderly patients, 33.7% of TB-related deaths occurred at the time of diagnosis [ 18 ]. However, this study did not consider mortality from tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Identifying Risk Factors for Pulmonary Tuberculosis Diagnosis Delays in Mali a West-African Endemic Country

Soumaré¹,

Baya²,

Ouattara³

et al. 2022

JTR

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Background: Tuberculosis was the deadliest infectious agent before covid-19; 1.5 million deaths in 2020. Despite, a variety, of easy and cheap diagnostic tools, detection rates still fall below 90%; diagnosis delays are long exceeding 30 days in many continents. This study aimed to determine risk factors for pulmonary TB diagnosis delays in Mali. Methods: A cross-sectional study was conducted in Bamako to include pulmonary TB patients at treatment initiation centers. Verbal consent was obtained before the interview. Demographics, clinical, treatment cost, and patient, medical, and diagnostic delays were computed using SPSS 25.0 considering a significance level p < 0.05. Results: In total 266 patients were included, 80.8% were male, mean age was ± 12 years, primary education level was 50.4%, treatment cost before diagnosis was 100 - 200 thousand CFA in 65.4%, smokers were 42.1%, median patient, medical and total diagnostic delays were 58, 57 and 114 days respectively. Education level below university, social reasons, and non-request of health workers were identified as independent risk factors for diagnostic delay > 100 days in Mali Conclusion: Diagnostic delay is relatively very long in Mali, there is an urgent need for identification and action to shorten the delays to limit the transmission chain and avoid disabling pulmonary sequels.

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Delayed diagnosis of tuberculosis: risk factors and effect on mortality among older adults in Hong Kong

Abstract: High mortality was observed among patients with TB aged ≥80 years. Increased vigilance is warranted to avoid delayed diagnosis and reduce the transmission risk, especially among elderly patients with co-morbidities living in old age homes.

Cited by 13 publications

References 20 publications

Clinical profiles and outcomes of pulmonary tuberculosis patients with delayed treatment at a tertiary hospital in South Korea

Clinical profiles and outcomes of pulmonary tuberculosis patients with delayed treatment at a tertiary hospital in South Korea

Delays in Seeking Medical Services in Elderly Patients With Senile Cataract

Identifying Risk Factors for Pulmonary Tuberculosis Diagnosis Delays in Mali a West-African Endemic Country

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