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

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.