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The European Journal of Public Health Advance Access published online on July 13, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki010
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved
Received July 3, 2003
Accepted April 6, 2004

Article

Determinants of health system delay among confirmed tuberculosis cases in Spain

M. Díez 1*, M.J. Bleda 1, J. Alcaide 2, C. Castells 3, J.I. Cardenal 4, A. Domínguez 2, P. Gayoso 5, G. Guitiérrez 6, C. Huerta 7, M.J. López 8, T. Moreno 9, F. Muñoz 10, A. García-Fulgueiras 11, M. Picó 12, F. Pozo 13, J.R. Quirós 14, F. Robles 15, J.M. Sánchez 16, H. Vanaclocha 17, T. Vega 18, and for the Multicentre Project for Tuberculosis Research (MPTR) Study Group

1 1 TB Research Unit, National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain
2 2 Directorate-General of Public Health, Catalonian Regional Authority, Barcelona, Spain
3 3 Regional Health Authority, Basque Country Regional Authority, Bilbao, Spain
4 4 Directorate-General of Public Health, Extremaduran Regional Authority, Badajoz, Spain
5 5 Cristal-Piñor Hospital Complex, Orense, Spain
6 6 Directorate-General of Public Health, Castile-La Mancha Regional Authority, Toledo, Spain
7 7 Spanish Pharmaco-epidemiological Research Centre, Madrid, Spain
8 8 Directorate-General of Public Health, La Rioja Regional Authority. Logroño, Spain
9 9 Nursing Research Co-ordination & Development Unit, Carlos III Institute of Public Health. Madrid, Spain
10 10 Valme University Teaching Hospital, Seville, Spain
11 11 Epidemiology Department, Regional Authority for Health & Consumer Affairs, Murcia, Spain
12 12 Directorate-General of Public Health, Andalusian Regional Authority, Seville, Spain
13 13 Doce de Octubre Hospital, Madrid, Spain
14 14 Directorate-General of Public Health, Principality of Asturias, Oviedo, Spain
15 15 Regional Health Authority, Melilla Regional Authority, Melilla, Spain
16 16 Regional Authority for Health, Consumer Affairs & Sports, Ceuta Regional Authority, Ceuta, Spain
17 17 Directorate-General of Public Health, Valencian Regional Authority, Valencia, Spain
18 18 Directorate-General of Public Health & Health Care, Castile & León Regional Authority, Valladolid, Spain

* To whom correspondence should be addressed.
M. Díez, E-mail: mdiez{at}isciii.es


  Abstract

Background: Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients. Methods: Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables. Results: A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged. Conclusion: Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.

Keywords: female TB cases; health system delay; HIV-related TB; intravenous drug user (IDU).
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