Temporal Trends and Heterogeneous Distribution of Tuberculosis Care Delays in Western China: A 21-Year Retrospective Study from a Regional Surveillance System
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background and Objective Delays in TB care remain a major barrier to effective disease control, particularly in poor and resource-limited areas. Although previous studies have examined diagnostic and treatment delay in different settings, long-term evidence simultaneously evaluating multiple stages of delay and their relationship with treatment outcomes remains limited. This study aimed to investigate the temporal trends, associated factors, and outcome relevance of consultation delay, diagnostic delay, treatment delay, and total delay among patients with pulmonary TB in Ningxia Hui Autonomous Region, China, from 2005 to 2025. Methods This retrospective surveillance-based cohort study used data from the Tuberculosis Information Management System of Ningxia. A total of 53,140 patients with pulmonary TB registered between January 1, 2005 and December 31, 2025 were included in the baseline and delay analyses. Consultation delay was defined as the interval from symptom onset to the first medical visit, diagnostic delay as the interval from the first medical visit to confirmed diagnosis, treatment delay as the interval from diagnosis to treatment initiation, and total delay as the interval from symptom onset to treatment initiation. Annual trends in delay indicators were assessed using Joinpoint regression. Group differences were compared using Mann–Whitney U and Kruskal–Wallis H tests. Multivariable linear regression models were used to identify factors associated with each type of delay. Spearman correlation analysis was performed to evaluate the association between delay indicators and unfavorable treatment outcomes. Results Among the 53,140 patients, most were male (56.9%), aged 18–44 years (34.9%), farmers/herders/fishers (65.5%), and identified through referral/transfer (48.5%). Consultation delay and total delay showed an overall declining trend during the study period, whereas diagnostic delay and treatment delay remained consistently short. The annual median consultation delay decreased from 33 days in 2005 to 16 days in 2017, but rebounded to 35 days in 2023–2024. Total delay decreased from 45 days in 2005 to 27 days in 2015–2017, then increased to 44–45 days in 2023–2024. Joinpoint analysis showed a significant decline in consultation delay from 2005 to 2019 (APC = − 4.11%, 95% CI: −6.83% to − 1.66%) and in total delay from 2005 to 2015 (APC = − 4.47%, 95% CI: −11.55% to − 0.71%), followed by a significant increase in total delay after 2015 (APC = 4.07%, 95% CI: 2.37% to 11.49%). Longer delays were observed among older patients, farmers/herders/fishers, self-presenting patients, and bacteriologically positive cases, whereas referral/transfer and active screening were associated with shorter delays. Unfavorable treatment outcomes were weakly but significantly negatively correlated with all delay indicators. Conclusion The burden of delay in TB care in Ningxia was concentrated mainly before patients first entered the healthcare system, with consultation delay contributing most to total delay. Although the overall trend improved over time, the later rebound indicates that progress in timely TB care remains unstable. Delays were unevenly distributed across patient groups, particularly affecting socially and programmatically disadvantaged populations. These findings highlight the need for earlier symptom recognition, more proactive case-finding, and targeted interventions for high-risk groups to improve patient outcomes, reduce transmission, and strengthen TB control in poor areas of western China.
Source: Research Square
Authors: Guangtian Liu, Huijuan Wang, Li Wang, Jiangping Li
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7163662898