Health-seeking delay and potential determinants among pulmonary tuberculosis patients: a retrospective survey in China

Background Understanding the health-seeking delay (HSD) in pulmonary tuberculosis (PTB) patients aids tailored strategies to curb transmission. This study aims to assess HSD and factors in China, considering the COVID-19 impacts. Methods Symptomatic PTB patients diagnosed from 2019 to 2022 were sampled using multistage stratified clustering. A semi-structured questionnaire was utilized to assess their HSD. Participants were divided to pre (2019) and epidemic (2020–2022) groups, the latter further categorized to 12 subgroups byⅠ–Ⅳstages and 3 levels of stringency in public health and social measures(PHSMs). Categorical variables were presented as counts (percentages), while continuous as median (Interquartile Range). The time between patient onset symptom and initial health facility visiting was defined as the health-seeking interval (HSI), HSIs of epidemic group and subgroups were compared with those of the 2019. Factors associated with HSD were analysed, univariable and multivariable analysis were performed by chi-square tests and binary logistic regression separately. Results Sum of 759 PTB patients, 391 diagnosed pre and 368 during the epidemic. HSI was 14 (7–30) days for all patients, with no significant difference between two groups [12 (7–30) days vs . 15 (6–30) days, P  = 0.852]. Among the 12 subgroups, only under strict PHSMs in stage I and medium PHSMs in stage II showed significant differences in HSIs compared to 2019[10 (3–15) days vs . 20 (10–30) days, 10 (3–17.5) days vs . 20 (8.5–50) days] ( P  = 0.013, 0.038). HSD proportions were comparable between the two groups (48.1% vs . 51.6%, P  = 0.328). Self-medication before seeking health was a common factor for HSD (AOR: 3.057/2.868, 95% CI: 1.888–4.950/1.718–4.787). During the epidemic, solely cough and expectoration were prone to HSD (AOR: 2.144, 95% CI: 1.288–3.569), and passive case-finding posed a higher HSD risk than active (AOR: 30.987, 95% CI: 3.904-245.932). Most patients with HSD misinterpreted PTB, while a few cited epidemic inconvenience and fear of COVID-19. Conclusions HSD among PTB patients remains prevalent, the COVID-19 epidemic exerted limited impact. Individual, epidemic and health provider factors mediated the HSD. Increasing PTB awareness, enhancing health services accessibility during epidemics, and expanding active case-finding are recommended to minimize the delays.