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Free Content The effect of geographical distance on TB patient delays in a mountainous province of China

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SETTING: One hundred and twenty-nine counties in Yunnan, a mountainous province in China.

OBJECTIVE: To document the relationship between patient delays and distance to local county tuberculosis (TB) centres.

DESIGN: A computerised medical record-based study of a cohort of 10356 new smear-positive TB cases in 2005.

RESULTS: The median total delay was 71 days (interquartile range [IQR] 38–128), with a median long patient delay of 60 days (IQR 28–111) and a relatively short median health care system delay of 4 days (IQR 2–13). Older age (>40 years), being an agriculturer and poor economic status were significantly associated with longer patient delays. Risk of delay increased with increasing geographical distance, with a greater effect on relatively shorter patient delays. Using the first quartile of distance as the reference group, hazard ratios for subsequent quartiles were 0.61 (0.57–0.65), 0.30 (0.28–0.33) and 0.15 (0.14–0.17) for short patient delays (≤60 days), and 1.04 (0.94–1.17), 0.69 (0.63–0.77) and 0.43 (0.39–0.47) for long patient delays (>60 days).

CONCLUSION: Patients living in remote areas need support to overcome the barrier posed by geographical distance, which has a greater effect in the initial phases of the disease.
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Keywords: China; delay; geographical distance; mountainous area; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Yunnan Provincial Centers for Disease Control and Prevention, Yunnan, China 2: Epidemiology Unit, Medicine Faculty, Prince of Songkla University, Hat Yai, Thailand

Publication date: 2008-03-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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