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目的了解户籍与流动人口肺结核患者的就诊延迟现状及其影响因素。方法采用单纯随机抽样方法选取山东省4个全球基金项目县,通过自制问卷对目标县登记的肺结核患者进行调查。结果调查的928例患者中户籍人口患者595例(64.1%),流动人口患者333例(35.9%),中位年龄分别为51和28岁,就诊间隔的中位天数分别为30和17 d,就诊延迟率分别为66.4%和56.2%;多因素logistic回归分析结果显示,咳嗽咳痰(OR=3.0,95%CI=1.6~5.6)、痰检阳性(OR=1.7,95%CI=1.0~2.9)、就诊患者(OR=7.6,95%CI=2.7~21.0)和转诊患者(OR=9.0,95%CI=3.1~26.2)是户籍人口患者就诊延迟的危险因素,咯血(OR=0.4,95%CI=0.2~0.9)是其保护因素;咳嗽咳痰(OR=2.3,95%CI=1.4~3.7)、痰检阳性(OR=1.9,95%CI=1.3~2.8)、就诊患者(OR=3.8,95%CI=1.8~8.0)和转诊患者(OR=5.6,95%CI=2.5~12.3)是流动人口患者就诊延迟的危险因素。结论无论户籍还是流动人口,对肺结核疑似症状的警惕性不强,缺乏及时到医疗卫生机构就诊的意识是其就诊延迟的主要原因,需采取针对性措施予以改进。
Objective To understand the status quo and the influencing factors of postponement of pulmonary tuberculosis among registered permanent residents and floating population. Methods Four global fund project counties in Shandong Province were selected by a simple random sampling method and were surveyed by self-made questionnaires for tuberculosis patients registered in the target counties. Results Of the 928 patients surveyed, 595 (64.1%) had census register and 333 (35.9%) had mobile population with a median age of 51 and 28 years respectively. The median days of visit were 30 and 17 days respectively, Multivariate logistic regression analysis showed that cough and expectoration (OR = 3.0, 95% CI = 1.6-5.6), positive sputum examination (OR = 1.7,95% CI = 1.0-6.5) (OR = 7.6, 95% CI = 2.7-21.0) and referral patients (OR = 9.0, 95% CI 3.1-2.2.2) were the risk factors for the delayed treatment of patients in the census register, with hemoptysis (OR = 0.4 (OR = 2.3, 95% CI = 1.4 ~ 3.7), positive sputum examination (OR = 1.9, 95% CI = 1.3-2.8) (OR = 3.8, 95% CI = 1.8-8.0) and referral patients (OR = 5.6,95% CI = 2.5-12.3) were the risk factors for delayed treatment in floating population. Conclusion Regardless of household registration or floating population, the vigilance against the suspected symptoms of tuberculosis is not strong. The lack of prompt awareness to the medical and health institutions is the main reason for the delay of their visits and need to take targeted measures to be improved.