ArticleBMJ open2018
Determinants of patient and health system delay among Italian and foreign-born patients with pulmonary tuberculosis: a multicentre cross-sectional study.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- Tuberculosis in adult migrants in Europe: a TBnet consensus statement.The European respiratory journal · 2025Pooled it
- Trial
- A rapid review of the causes of diagnostic and treatment delays for tuberculosis in low-burden countries.Journal of public health (Oxford, England) · 2025Review
- Trends and delays in pulmonary tuberculosis diagnosis among elderly patients (≥ 60 Years) in Southern China: a 13-year surveillance data analysis (2010-2022).BMC public health · 2025Article
- The Impact of the Seasonal and Geographical Distribution of Tuberculosis in Sicily: A 6-Year Retrospective Study (2018-2023).Journal of clinical medicine · 2024Article
- Magnitude and factors associated with delay in treatment-seeking among new pulmonary tuberculosis patients in public health facilities in Habro district, eastern Ethiopia.Health services insights · 2024Article
- Delay in seeking treatment and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel zone, Benishangul Gumuz region, Western Ethiopia.Frontiers in public health · 2024Article
- Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal.BMC public health · 2023Article
- Article
- Trends of a decade in risk factors of patient delay among pulmonary tuberculosis patients during fast aging and urbanization - analysis of surveillance data from 2008 to 2017 in Wuhan, China.BMC public health · 2023Article
- Epidemiology and Association Rules Analysis for Pulmonary Tuberculosis Cases with Extrapulmonary Tuberculosis from Age and Gender Perspective: A Large-Scale Retrospective Multicenter Observational Study in China.International journal of clinical practice · 2023Observational
- Health system delay and its associated factors among tuberculosis patients in Gamo Zone public health facilities, Southern Ethiopia: An institution-based cross-sectional study.Journal of clinical tuberculosis and other mycobacterial diseases · 2022Article
- Delayed Tuberculosis Treatment and Cost of Care in a Low-Incidence Country.Open forum infectious diseases · 2022Article
- Gender Differences in Factors Associated with the Total Delay in Treatment of Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Selangor, Malaysia.International journal of environmental research and public health · 2022Article
- Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system.European journal of public health · 2021Observational
- Treatment delay in childhood pleural tuberculosis and associated factors.BMC infectious diseases · 2020Article
- Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana.PloS one · 2020Article
- Delay in treatment seeking and associated factors among suspected pulmonary tuberculosis patients in public health facilities of Adama town, eastern Ethiopia.BMC public health · 2019Article
- Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome.BMJ open respiratory research · 2019Article
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe aim of this cross-sectional study was to identify key factors associated with patient delay (PD), health system delay (HSD) and total delay (TOTD) in patients with tuberculosis (TB) to inform control programmes.
settingThe study was conducted in four Italian regions in 2014-2016. Data were obtained using a questionnaire including: sociodemographic and lifestyle data, TB comorbidities, patient knowledge and attitudes towards TB, stigma, access to TB care and health-seeking behaviours.
participantsPatients' inclusion criteria were being diagnosed as a new smear positive pulmonary TB case and living in one of the participating Italian regions. Overall, 344 patients from 30 healthcare centres were invited to participate and 253 patients were included in the analysis (26.5% non-response rate); 63.6% were males and 55.7% were non-Italian born. OUTCOME MEASURES: Risk factors for PD, HSD and TOTD in patients with TB were assessed by multivariable analysis. Adjusted ORs (aOR) and 95% CIs were calculated.
resultsMedian PD, HSD and TOTD were 30, 11 and 45 days, respectively. Factors associated with longer PD were: stigma (aOR 2.30; 95% CI 1.06 to 4.98), chest pain (aOR 2.67; 95% CI 1.24 to 6.49), weight loss (aOR 4.66; 95% CI 2.16 to 10.05), paying for transportation (aOR 2.66; 95% CI 1.24 to 5.74) and distance to the health centre (aOR 2.46; 95% CI 1.05 to 5.74) (the latter three were also associated with TOTD). Shorter HSD was associated with foreign-born and female status (aOR 0.50; 95% CI 0.27 to 0.91; aOR 0.28; 95% CI 0.15 to 0.53, respectively), dizziness (aOR 0.18, 95% CI 0.04 to 0.78) and seeking care at hospital (aOR 0.35; 95% CI 0.18 to 0.66). Prior unspecific treatment was associated with longer HSD (aOR 2.25; 95% CI 1.19 to 4.25) and TOTD (aOR 2.55; 95% CI 1.18 to 5.82). Haemoptysis (aOR 0.12; 95% CI 0.03 to 0.43) and repeated visits with the same provider (aOR 0.29; 95% CI 0.11 to 0.76) showed shorter TOTD.
conclusionsThis study identifies several determinants of delays associated with patient's behaviours and healthcare qualities. Tackling TB effectively requires addressing key risk factors that make individuals more vulnerable by the means of public health policy, cooperation and advocacy to ensure that all patients have easy access to care and receive high-quality healthcare.
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