Treatment Delay and Total Delay among Pulmonary Tuberculosis Patients in the North of Iran: Application Survival Data Analysis

BACKGROUND Tuberculosis (TB) remains the leading cause of death among infectious diseases worldwide. Identifying the factors associated with the treatment delay and total delay would be helpful in the prevention of tuberculosis and in reducing the burden on the health care system. The objective of this study was to assess the treatment delay and total delay in TB patients and investigate the factors causing these delays. MATERIALS AND METHODS This was a longitudinal study conducted in 2009-2015. Our study consisted of 1694 TB patients registered in the TB center of Mazandaran province. Data regarding the patients' demographic characteristics and clinical factors associated with treatment delay and total delay were analyzed. Kaplan Meier plots and log rank tests were used to assess the survival pattern. Cox proportional hazards model for multivariable analysis was discussed. We used mean values and median (Q2) [first quartile (Q1)-third quartile (Q3)] to describe delays. RESULTS The median treatment delay and total delay were 35 (ranged 23-80) and 36 (ranged 24-82) days, respectively. The mean age of TB patients was 47.40±20.3. No significant association was found between the location of residence, nationality, gender, and type of pulmonary TB patients with treatment delay and total delay. Additionally, age, prison status of patients, HIV test, and contact history had a significant relationship with the treatment delay and total delay (p-value <0.05). It was shown that the median total delay in men patients in the ≤14 year-old age group, imprisoner patients, rural patients, patients who have not received an HIV test, smear negative patients, those who are Iranian, and TB patients whose contact history was unknown was lower than that of others. The highest median treatment delay and total delay was in the >60 age groups, and were 41 and 44 days, respectively. Treatment delay was the same as the total delay except in the place of residence variable; median treatment delay among urban patients was less than that of rural patients. CONCLUSION According to this study age, prison status of patients, HIV test and contact history had a significant relationship with the treatment delay and total delay (P-value<0.05). Understanding the factors that are closely associated with these delays is essential to effectively control TB and could be helpful in reducing these delays.