Delay in the diagnosis of pulmonary tuberculosis, London, 1998-2000: analysis of surveillance data

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Abstract
Methods and results We analysed surveillance data collected by doctors (1999-2000) and an anonymised national survey (1998) for cases of tuberculosis in London from 1998 to 2000. We calculated the delay in diagnosis as the number of days between the onset of symptoms and diagnosis or the start of treatment (which were on the same day in cases with both recorded). Delay was characterised as greater than the median or at or less than the median. We used unconditional logistic regression to investigate factors that were independently associated with delay. View this table: In this window In a new window Table 1. Odds ratios for delay in the diagnosis of tuberculosisin patients testing positive for tuberculosis in smear tests, London, 1998 to 2000* A total of 1355 patients had a positive result in smear tests of pulmonary sputum; we give results for 853 (63%) about whom data on the time between onset of symptoms and diagnosis had been recorded. Patients with data and those without were similar for age, sex, and ethnic group. The median age was 34 (interquartile range 26-51) years; 505/849 (60%) of patients were men. A total of 263/842 (31%) patients were white and 267/842 (32%) were black; 542/782 (69%) of patients were born outside the United Kingdom. Median delay was 49 (14-103) days. Univariate analysis showed that factors significantly associated with delay of longer than 49 days until diagnosis or treatment were age, birthplace (United Kingdom or overseas), sex, and ethnic group (table). The geometric mean delay in days were 72 (95% confidence interval 63 to 80) among white patients and 43 (39 to 45) among all other ethnic groups, 72 (66 to 77) among women and 61 (56 to 65) among men, and 64 (55 to 74) among those aged ≥40 years and 45 (40 to 51) among patients aged <40 years. Among patients not born in the United Kingdom, time since entry was significantly positively associated with delay being greater than the median (P=0.01). In multivariate analysis, delays were more likely for white patients (adjusted odds ratio 1.67 (1.2 to 2.5); P=0.01) and women (1.42 (1.1 to 1.9); P=0.01). Age and birth place were not independently associated with delay.