目的 了解广西壮族自治区(简称广西)肺结核患者发现延迟情况及影响因素,为科学制定结核病防控措施提供参考依据。方法 从中国疾病预防控制信息系统结核病信息管理系统导出登记日期为2019—2024年广西肺结核患者病案资料,共纳入207 027例患者。采用χ²趋势检验分析肺结核患者发现延迟的时间变化,多因素logistic回归识别影响因素。结果 2019—2024年广西肺结核患者发现延迟率为54.36%(112 537/207 027),中位延迟时间为32(14,70)d。2019—2022年延迟率呈下降趋势(年均递降率为0.30%,χ ${ }_{\mathrm{趋}\mathrm{势}}^{2}$=76.132,P<0.001),但2023—2024年回升至56.69%。男性延迟率(54.91%)高于女性(52.93%),45~64岁组延迟率最高(57.17%),农民(56.91%)、无业/离退人员(50.53%)延迟率高于有固定职业者(43.81%)。防城港市(65.27%)、钦州市(63.93%)延迟率排名居前,但钦州市年均递降率较高(1.94%)。多因素logistic回归分析结果显示,与<24岁患者相比,45~64岁患者(OR=1.158,95%CI:1.109~1.208)发生发现延迟的风险较高;与有固定职业患者相比,无业/离退(OR=1.340,95%CI:1.277~1.406)、农民(OR=1.499,95%CI:1.436~1.565)患者发生发现延迟的风险较高,而学生患者(OR=0.840,95%CI:0.784~0.901)发生发现延迟的风险较低;与来源于因症就诊/推介的患者相比,来源于追踪的患者(OR=1.152,95%CI:1.110~1.196)发生发现延迟风险的较高,而来源于转诊(OR=0.876,95%CI:0.854~0.898)、健康体检/主动筛查(OR=0.380,95%CI:0.344~0.419)的患者发生发现延迟的风险较低;与首诊机构为自治区级的患者相比,首诊机构为地市级(OR=0.625,95%CI:0.606~0.646)、县(市、区)级(OR=0.875,95%CI:0.848~0.902)患者发生发现延迟的风险较低;与初治患者相比,复治患者(OR=1.196,95%CI:1.157~1.237)发生发现延迟的风险较高。结论 广西肺结核患者发现延迟问题突出,需重点加强45~64岁、农民、复治人群的主动筛查。

Objective To understand the status and influencing factors of diagnostic delay in tuberculosis patients in Guangxi Zhuang Autonomous Region (abbreviated as Guangxi),and to provide reference for scientifically formulating tuberculosis prevention and control measures. Methods Data of tuberculosis patients registered from 2019 to 2024 in Guangxi were exported from the Tuberculosis Information Management System of the Chinese Disease Prevention and Control Information System,with a total of 207 027 patients included.The chi-square trend test was used to analyze temporal changes of delayed detection in patients with pulmonary tuberculosis,and multivariate logistic regression was employed to identify influencing factors. Results From 2019 to 2024,the diagnostic delay rate among tuberculosis patients in Guangxi was 54.36% (112 537/207 027),with a median delay time of 32 (14,70) days.The delay rate showed a decreasing trend from 2019 to 2022 (annual decrease rate: 0.30%,χ ${ }_{trend}^{2}$=76.132,P<0.001),but rebounded to 56.69% in 2023-2024.The delay rate was higher in males (54.91%) than in females (52.93%),and the delay rate was the highest in the 45-64 age group (57.17%).Farmers (56.91%) and unemployed/retired individuals (50.53%) had higher delay rates than those with stable occupations (43.81%).Fangchenggang (65.27%) and Qinzhou (63.93%) had the highest delay rates,but Qinzhou exhibited a significant annual decrease rate (1.94%).Multivariate logistic regression analysis revealed that compared to patients aged <24 years,those aged 45-64 (OR=1.158,95%CI:1.109-1.208) had a higher risk of diagnostic delay.Compared to patients with stable occupations,unemployed/retired individuals (OR=1.340,95%CI:1.277-1.406) and farmers (OR=1.499,95%CI:1.436-1.565) had higher risk of diagnostic delay,while students (OR=0.840,95%CI:0.784-0.901) had a lower risk of diagnostic delay.Compared to patients detected due to symptoms/recommendation,those identified through contact tracing (OR=1.152,95%CI:1.110-1.196) had a higher risk of diagnostic delay,while those diagnosed through referral (OR=0.876,95%CI:0.854-0.898) or health checkups/active screening (OR=0.380,95%CI:0.344-0.419) had lower risk of diagnostic delay.Compared to patients first diagnosed at autonomous region-level facilities,those first diagnosed at prefecture-level (OR=0.625,95%CI:0.606-0.646) or county (city,district) level (OR=0.875,95%CI: 0.848-0.902) institutions had lower risk of diagnostic delay.Compared to new patients,retreated patients (OR=1.196,95%CI:1.157-1.237) had higher risk of diagnostic delay. Conclusion The issue of diagnostic delay in tuberculosis patients in Guangxi is prominent,and enhanced the active screening for high-risk groups (aged 45-64,farmers,and retreated cases),are urgently needed.