Demographic and clinical characteristics in relation to patient and health system delays in a tuberculosis low-incidence country

Background: Delays in the diagnosis and treatment of tuberculosis (TB) are commonly encountered. Methods: A study was undertaken among pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) patients in a Danish university hospital to describe demographic and clinical characteristics in relation to delay. Results: Of the 313 patients enrolled, 213 (68%) were diagnosed with PTB and 100 (32%) with EPTB only. Logistic regression analysis of EPTB showed an association with female sex and non-Danish ethnicity. Mean total delay from onset of symptoms until initiation of TB treatment was 123 (95% confidence interval (CI) 106-138) days. Mean patient delay was significantly longer than mean health system delay: 90 (95% CI 74-105) vs 33 (95% CI 23-44) days (p < 0.0001). Delay was independent of ethnicity and significantly shorter for PTB patients compared to EPTB patients. Fever was found to be strongly predictive of a short patient delay (<1 month), whereas weight loss was associated with a long patient delay (>3 months). In contrast, weight loss was associated with a short health system delay (<1 week). Elevated inflammatory markers were also associated with a short delay in the diagnosis of TB. Conclusions: This study confirmed a typical delay of months in duration in the diagnosis and treatment of TB in the low endemic country of Denmark. Increased TB awareness is needed, in particular in communities with immigrants originating from high-endemic areas.