Diagnostic delay in tuberculosis in Yorkshire &amp; Humber, UK: 2013-16 data

Gissing, Stefanie; Bindra, Renu

doi:10.1183/13993003.congress-2018.pa5267

Cited by 3 publications

(3 citation statements)

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“…The increased risk of both presentation and healthcare delay experienced by females is a common finding around the world and in the UK 8 14 18 23 27–29. In our study, this association was no longer found if we lowered the threshold for presentation delay.…”

Section: Discussioncontrasting

confidence: 57%

“…Nevertheless, the association with healthcare delay persisted, suggesting an inherent bias in suspicion of TB or even other health issues by health providers. White ethnicity as compared with Asian ethnicity has also been associated with longer overall delay in other studies in the UK 27 28. White ethnicity in our study could be associated with vulnerable and marginalised groups which are likely to have a delay in presentation.…”

Section: Discussionsupporting

confidence: 50%

“…The longer healthcare delay for people of white ethnicity could be explained by a heightened clinical suspicion and investigation in Asian ethnicities. The association of increasing age with overall delay was found in many studies 17 18 24 28. While underlying medical conditions or more common alternative diagnoses could result in a healthcare delay among older people, it is not clear why they should present later.…”

Section: Discussionmentioning

confidence: 99%

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Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome

et al. 2019

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BackgroundA quarter of London’s pulmonary tuberculosis (TB) patients have over 4 months of delay. Late diagnosis increases disease severity and the risk of transmission. We aim to classify delays, identify associated risk factors and assess treatment outcome.MethodsWe conducted a retrospective cohort study using London surveillance data, 2012–2018 on adults aged ≥18 years with pulmonary TB. We defined presentation delay (days from symptom onset to first healthcare visit) and healthcare delay (first healthcare visit to treatment commencement) as dichotomous variables; positive delay being days equal or greater than the third quartile. We applied logistic regression models to identify risk factors associated with delays and treatment outcome at 12 months.ResultsOf 7216 people, 4539 reported presentation and 5193 healthcare delays. The third quartiles for presentation and healthcare delay were 84 and 61 days, respectively. Presentation delay was associated with female sex (adjusted OR (aOR)=1.21; 95% CI 1.04 to 1.39), increasing age (aOR=1.004; 95% CI 1.001 to 1.008), white compared to Asian ethnicity (aOR=1.35; 95% CI 1.12 to 1.62), previous imprisonment (aOR=1.66; 95% CI 1.22 to 2.26) and alcohol misuse (aOR=1.44; 95% CI 1.04 to 1.89). Healthcare delay was associated with female sex (aOR=1.39; 95% CI 1.21 to 1.59), increasing age (aOR=1.014; 95% CI 1.009 to 1.018) and white ethnicity (aOR=1.41; 95% CI 1.19 to 1.68). 16% of 5678 people with known outcome did not complete treatment. Neither delay was associated with non-completion (p value <0.05).ConclusionsFemale, white and older people with TB were more likely to experience both presentation and healthcare delays. Social risk factors were also associated with delay in presentation. Early diagnosis and treatment remain critical to reduce transmission, regardless of whether delay affected completion.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

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Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome

et al. 2019

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Factors associated with delay in treatment initiation for pulmonary tuberculosis

et al. 2020

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BackgroundDelays in treatment initiation for tuberculosis (TB) may lead to worse clinical outcomes and increased transmission. We aimed to determine factors associated with treatment delays, to guide public health action.MethodsWe extracted data on clinical characteristics and documented potential barriers to treatment from all pulmonary TB cases with clinical case review data from 2011 to 2015 and linked these to TB surveillance data. We described the distribution of delays from symptom onset to first presentation (“presentation delay”) and from presentation to treatment (“healthcare delay”). We calculated time ratios (TRs) to determine the association between sociodemographic and clinical factors and delay outcomes.ResultsMedian presentation delay was 30 days (interquartile range (IQR) 11–72 days). Language barriers were associated with 40% longer presentation delay (TR 1.40, 1.01–1.94). Median healthcare delay was 40 days (IQR 13–89 days), and mostly consisted of the time taken before deciding to refer to TB specialists (median 26 days, IQR 4–73 days). Shorter healthcare delay was associated with positive sputum smear (TR 0.58, 0.47–0.70), UK residency <2 years (TR 0.47, 0.32–0.67), male sex (TR 0.74, 0.60–0.91) and secondary care referral (TR 0.63, 0.51–0.78).ConclusionsOur findings support continued initiatives to enable access to care for migrant populations to minimise presentation delay. Multifaceted approaches to increase clinician awareness of TB clinical presentations, to implement systems enabling early case recognition, to maximise the yield from sputum smear investigations and to ensure rapid diagnosis of smear negative cases are required to achieve further TB control.

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Musculoskeletal tuberculosis in Bradford

et al. 2022

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Aims Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford. Methods An observational study was conducted, using data from the Bradford Teaching Hospitals TB database of patients with a formal diagnosis of MSK TB between January 2005 and July 2017. Patient data included demographic data (including nationality/date of entry to the UK), disease focus, microbiology, and management strategies. Disease incidence was calculated using population data from the Office for National Statistics. Poisson confidence intervals were calculated to demonstrate the extent of statistical error. Disease incidence and nationality were also analyzed, and correlation sought, using the chi-squared test. Results Between January 2005 and July 2017, 109 cases of MSK TB were diagnosed in Bradford. Mean incidence was 1.65 per 100,000 population, per calendar year (SD 0.75). A total of 38 cases required surgical intervention. Low rates of antimicrobial resistance were encountered. A low rate of loss to follow-up was observed (four patients; 3.7%). Overall, 94.5% of patients (n = 103) were successfully treated. 67% of patients (n = 73) reported their country of origin as either India, Pakistan, or Bangladesh. These ethnicities account for around 25% of the local population. Conclusion Bradford maintains a high prevalence of MSK TB infection relative to national data; the prevalence within the local immigrant population remains grossly disproportionate. Typical associated factors (HIV/hepatitis coinfection, drug resistance), have only modest prevalence in our dataset. However, local socioeconomic factors such as deprivation and poverty appear germane as suggested by global literature. We advocate a high degree of suspicion in treatment of atypical infection in any area with similar population factors to ensure timely diagnosis. Cite this article: Bone Jt Open 2022;3(5):432–440.

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Diagnostic delay in tuberculosis in Yorkshire & Humber, UK: 2013-16 data

Cited by 3 publications

References 0 publications

Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome

Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome

Factors associated with delay in treatment initiation for pulmonary tuberculosis

Musculoskeletal tuberculosis in Bradford

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