Abstract
BACKGROUND: The prevalence of delays in receiving effective tuberculosis (TB) prevention and control measures is notably high, particularly among elderly patients. This study aims to explore the trends in diagnostic delays and assess the factors associated with these delays among elderly pulmonary tuberculosis (PTB) patients in Guangdong Province, Southern China. METHODS: We analyzed surveillance data from the Tuberculosis Information Management System (TBIMS), covering pulmonary tuberculosis cases in Guangdong Province from 2010 to 2022. We categorized patient delay (PD), health system delay (HSD), and total diagnostic delay (TDD) among patients aged 60 years and older. Trends in annual delays were examined using a Joinpoint regression program. Both univariate and multivariate logistic regression analyses were conducted to identify factors influencing TDD. RESULTS: The study found that the notification rate of PTB among elderly patients decreased from 155.85 per 100,000 in 2010 to 71.15 per 100,000 in 2022. However, the proportion of elderly patients among newly diagnosed TB cases increased from 20.66% to 30.37%. The median PD decreased from 29 days to 21 days, while the median HSD increased from 0 days to 3 days. Consequently, the TDD remained stable at 32 days. The average delay rates for PD, HSD, and TDD were 64.80%, 13.90%, and 75.80%, respectively. Joinpoint regression analysis showed a decreasing trend in PD rate and an increasing trend in HSD rate among patients aged ≥ 60 years, but no statistically significant change in TDD rate was observed. Significant risk factors for higher TDD included being a farmer, first visit to non-designated facilities, initial diagnosis at county-level hospitals, passive case finding, residence in underdeveloped areas, and respiratory comorbidities. CONCLUSIONS: The burden and delays associated with TB diagnosis remain significant among the elderly in Southern China. Enhanced health education and proactive screening efforts are crucial for this high-risk group to mitigate diagnostic delays, particularly for those with respiratory comorbidities and in less developed regions. Future research should focus on addressing these barriers and evaluating the effectiveness of tailored interventions to improve TB control strategies for the elderly.