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Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal
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Resumo(s)
Background: Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms. Methods: A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 – 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR). Results: The study included 75 patients. Median PD was 25 days (IQR 11.5–63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05–2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77–2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14–4.82)], while living in Oporto [PR 0.35 (95% CI 0.16–0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17–0.94)] were protective factors. Conclusions: These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.
Descrição
Funding Information: This work was supported by the Fundação para a Ciência e Tecnologia (FCT, Portugal) [Grant: PTDC/SAU-PUB/31346/2017]. The present publication was funded by Fundação para a Ciência e Tecnologia (FCT, Portugal) national support through Comprehensive Health Research Centre (CHRC) [UIDP/04923/2020]. Funding Information: The authors thank the participants. A special acknowledgment to Professor Carla Nunes, deceased meanwhile and former principal investigator of URBANTB. URBANTB group Patrícia Soares4, 10, 11, ¥, *, Mário Carreira1, Sofia Pereira12, Catarina Alves2, Filipe Alves13, Ana Rodrigues3, Ana Moreira14, Márcia Cardoso14, Sandra Mota14, Ana Gomes2, Liliana Ferreira2, Marta Lopes2, Isabel Correia4, Juan Rachadell15, Maria Gameiro15, Ângela Dias5, Manuel Pereira16, Jorge Gonçalves6, Maria Gonçalves7, Adriana Taveira8, Celene Neves19, Lucinda Silva19, Maria Mendes19, Maria Teixeira19, Maria Pereira19, Milena Piedade19, Antónia Teixeira9, Carlos Carvalho20* Representative of the consortium1NOVA National School of Public Health, Public Health Research Centre, NOVA University Lisbon, Lisbon, Portugal2Central Lisbon Public Health Unit, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal3Multidisciplinary Unit for Biomedical Research, Biomedical Sciences Institute Abel Salazar, University of Porto, Oporto, Portugal4NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, NOVA University Lisbon, Lisbon, Portugal5Epidemiological Investigation Unit, Public Health Institute, University of Porto, Porto, Portugal6Laboratory for Integrative and Translational Investigation in Populational Health7Biomedical Sciences Institute Abel Salazar, University of Porto, Oporto, Portugal8Clinical Investigation Unit, Regional Health Administration of the North, Oporto, Portugal9Pneumology Service, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal10National Institute of Health Doutor Ricardo Jorge, Department of Epidemiology, Lisbon, Portugal11National Institute of Health Doutor Ricardo Jorge, Centre for Vectors and Infectious Diseases Research, Águas de Moura, Portugal12Amadora Public Health Unit, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal13Baixo Tâmega Public Health Unit, Regional Health Administration of the North, Marco de Canaveses, Portugal14Gaia Public Health Unit, Regional Health Administration of the North, Vila Nova de Gaia, Portugal15Occidental Lisbon and Oeiras Public Health Unit, Regional Health Administration of Lisbon and Tagus Valley, Paço de Arcos, Portugal16Loures-Odivelas Public Health Unit, Regional Health Administration of Lisbon and Tagus Valley, Santo António dos Cavaleiros, Portugal17Occidental Oporto Public Health Unit, Regional Health Administration of the North, Oporto, Portugal18Oriental Oporto Public Health Unit, Regional Health Administration of the North, Oporto, Portugal19Sintra Public Health Unit, Regional Health Administration of Lisbon and Tagus Valley, Mem Martins, Portugal20Vale do Sousa Sul Public Health Unit, Regional Health Administration of the North, Paredes, Portugal Publisher Copyright: © 2023, The Author(s).
Palavras-chave
Delayed diagnosis Help-seeking behaviour Patient delay Symptom perception Symptom valorisation Tuberculosis Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being