Figures
- FIGURE 1
Case data flow. ETS: Enhanced Tuberculosis Surveillance system. #: identified as tuberculosis contacts/by port health/by occupational health; ¶: delay of <1 day; +: these cases are included in descriptive analysis of “decision” and “referral” delays, but not other descriptive analyses, nor regression analyses of healthcare delay.
Tables
- TABLE 1
Presentation delay and healthcare delay by descriptive characteristics of people with pulmonary tuberculosis (TB), South East England, 2011–2015
Presentation delay Healthcare delay Cases with delay data Delay days Cases with delay data Delay days All 813 30 (11–72) 885 40 (13–89) Year 2011 38 51 (10–111) 44 34 (8–99) 2012 102 30 (12–70) 118 50 (14–99) 2013 224 28 (9–60) 232 32 (14–72) 2014 232 29 (12–62) 257 44 (14–94) 2015 217 31 (12–91) 234 43 (12–98) Unknown 0 0 Health protection team Hampshire Isle of Wight 132 33 (15–67) 132 39 (15–83) Kent 236 31 (13–86) 265 37 (9–87) Surrey Sussex 134 45 (17–111) 153 28 (9–70) Thames Valley 311 21 (8–53) 335 52 (18–102) Unknown 0 0 Cases by area TB incidence <20/100 000 554 31 (13–83) 615 43 (14–95) ≥20/100 000 259 24 (9–61) 270 32 (10–85) Unknown 0 0 Rurality Rural 70 39 (13–82) 78 38 (16–96) Urban 743 29 (11–70) 807 41 (12–89) Unknown 0 0 Sex Male 485 30 (12–81) 528 35 (10–78) Female 327 30 (11–62) 356 48 (19–111) Unknown 1 1 (1–1) 1 327 (327–327) Age group years 0–14 9 6 (4–20) 10 45 (33–51) 15–44 444 29 (12–67) 489 34 (10–79) 45–64 200 31 (193–80) 211 43 (14–96) ≥65 160 27 (9–84) 174 50 (17–129) Unknown 0 0 Time resident in UK years <2 years 96 33 (15–68) 105 31 (10–62) 2–10 years 248 28 (10–61) 274 34 (10–83) ≥11 years 167 23 (9–61) 174 55 (19–116) UK-born 283 31 (10–92) 309 44 (16–99) Unknown 19 64 (23–121) 23 26 (5–56) Social risk factor None 704 28 (10–66) 768 43 (14–98) 1 66 50 (26–121) 74 23 (7–71) ≥2 43 34 (17–88) 43 18 (5–65) Unknown 0 0 QIMD 1 (least) 140 31 (10–73) 158 46 (18–96) 2 139 29 (13–61) 156 47 (16–114) 3 191 26 (8–67) 208 42 (12–99) 4 231 31 (13–72) 247 40 (12–85) 5 (most) 112 34 (12–100) 146 20 (7–59) Unknown 0 0 Ethnicity Not white 501 27 (10–61) 541 38 (11–83) White 312 35 (13–92) 342 42 (15–100) Unknown 0 0 Language barriers# Present 88 32 (15–96) NC Absent 725 30 (11–68) NC Unknown 0 NC Mental health comorbidity# Present 31 43 (19–135) NC Absent 782 30 (11–68) NC Unknown 0 NC Physical health comorbidity# Present 75 30 (11–76) 799 41 (13–89) Absent 738 31 (12–56) 86 33 (15–95) Unknown 0 0 Post mortem diagnosis Yes 8 8 (5–91) NC No 805 30 (11–72) NC Unknown 0 NC Previous TB diagnosis Yes 51 31 (10–92) 57 38 (16–70) No 744 30 (11–67) 810 42 (13–94) Unknown 18 48 (7–105) 14 13 (5–19) Sputum smear Positive 379 31 (12–84) 406 25 (8–66) Negative 300 27 (11–65) 330 51 (20–107) Unknown 134 30 (11–64) 149 59 (27–132) Chest radiography Abnormal: TB NC 642 38 (12–83) Not TB or NAD NC 61 56 (19–129) Unknown NC 182 43 (15–88) Culture status Positive NC 720 38 (12–79) Negative NC 165 59 (19–132) Unknown NC 0 Referred by Primary care NC 340 51 (21–102) Secondary care NC 420 27 (8–78) Prison NC 4 40 (10–67) Private NC 5 162 (29–179) Unknown NC 116 54 (20–99) Data are presented as n or median (interquartile range). QIMD: Quintile of Index of Multiple Deprivation; NAD: no abnormality detected; NC: not calculated as not considered as a risk factor for this outcome. #: all unknown=“no”: the reporting form used by the TB nurses for cohort review had a simple tick box (tick means “yes”) for these variables. We have assumed if unticked that this meant “no”.
- TABLE 2
Median delay for different classifications of healthcare delay, South East of England, 2011–2015, and stratified by smear status
All healthcare delay# Decision delay Referral delay Diagnostic delay# Treatment initiation delay# Cases Delay days Cases Delay days Cases Delay days Cases Delay days Cases Delay days Any 885 40 (13–89) 784 26 (4–73) 788 2 (0–8) 605 2 (0–14) 889 1 (0–3) Negative 330 51 (20–107) 286 27 (5–79) 282 3 (0–13) 241 8 (1–31) 330 1 (0–4) Positive 406 25 (8–66) 365 17 (3–63) 369 1 (0–6) 266 1 (0–4) 410 1 (0–2) Data are presented as n or median (interquartile range). All categories exclude cases known to have been referred by public health contact tracing or screening. #: excludes cases diagnosed post mortem.
- TABLE 3
Crude and adjusted time ratio# of presentation delay by risk factor, for people with pulmonary tuberculosis (TB) in the South East of England, 2011–2015 (n=779)
Crude time ratio (95% CI) p-value Adjusted time ratio (95% CI) p-value Ethnicity Not white Ref. Ref. White 1.22 (0.99–1.50) 0.063 1.08 (0.82–1.42) 0.601 Mental health barriers No Ref. Ref. Yes 2.26 (1.37–3.75) 0.001 2.06 (1.22–3.50) 0.007 Rurality Rural Ref. Ref. Urban 0.92 (0.65–1.32) 0.656 0.88 (0.61–1.27) 0.500 Physical health comorbidity No Ref. Ref. Yes 0.86 (0.62–1.20) 0.366 0.75 (0.54–1.05) 0.091 Language barriers No Ref. Ref. Yes 1.25 (0.92–1.71) 0.160 1.40 (1.01–1.94) 0.042 Sex Female Ref. Ref. Male 1.10 (0.90–1.34) 0.335 1.04 (0.85–1.27) 0.698 Prior TB diagnosis No Ref. Ref. Yes 1.36 (0.92–2.02) 0.125 1.01(0.68–1.51) 0.953 Age group years¶ ≥65 Ref. Ref. 45–64 1.30 (0.97–1.74) 0.078 1.27 (0.95–1.72) 0.103 15–44 0.94 (0.72–1.21) 0.615 1.05 (0.79–1.41) 0.718 0–14 0.22 (0.08–0.56) 0.002 0.23 (0.09–0.59) 0.002 Social risk factors present+ None Ref. Ref. 1 1.44 (1.01–2.05) 0.043 1.18 (0.82–1.71) 0.362 ≥2 1.02 (0.65–1.59) 0.936 0.76 (0.47–1.21) 0.248 Time resident in UK§ UK-born Ref. Ref. ≥11 years 1.01 (0.77–1.18) 0.947 0.99 (0.71–1.39) 0.959 2–10 years 0.74 (0.59–0.95) 0.016 0.77 (0.56–1.04) 0.090 <2 years 0.86 (0.62–1.18) 0.350 0.84 (0.58–1.22) 0.366 QIMDƒ 1 (least deprived) Ref. Ref. 2 0.83 (0.59–1.16) 0.276 0.86 (0.64–1.24) 0.358 3 0.93 (0.58–1.28) 0.668 0.98 (0.73–1.36) 0.878 4 1.08 (0.79–1.49) 0.619 1.04 (0.75–1.43) 0.818 5 (most deprived) 1.19 (0.81–1.75) 0.381 1.20 (0.86–1.85) 0.341 QIMD: Quintile of Index of Multiple Deprivation. Bold type represents statistical significance at a p-value ≤0.05. #: all models include a random effect on 62 local authority districts; ¶: Wald p-value for overall effect of age group categorical variable crude <0.001, adjusted 0.003; +: Wald p-value for overall effect of social risk factor categorical variable crude 0.128, adjusted 0.275; §: Wald p-value for overall effect of time in UK categorical variable crude 0.058, adjusted 0.247; ƒ: Wald p-value for overall effect of QIMD categorical variable crude 0.306, adjusted 0.474.
- TABLE 4
Crude and adjusted time ratio# of healthcare delay by risk factor, for people with pulmonary tuberculosis (TB) in the South East of England, 2011–2015 (n=621)
Crude time ratio (95% CI) p-value Adjusted time ratio (95% CI) p-value Ethnicity Not white Ref. Ref. White 1.15 (0.92–1.43) 0.213 1.15 (0.87–1.51) 0.325 Physical health comorbidity No Ref. Ref. Yes 1.05 (0.74–1.50) 0.786 1.10 (0.78–1.56) 0.583 Sex Female Ref. Ref. Male 0.69 (0.56–0.85) <0.001 0.74 (0.60–0.91) 0.005 Prior TB diagnosis No Ref. Ref. Yes 0.92 (0.62–1.37) 0.690 0.95 (0.65–1.41) 0.815 Age group years¶ ≥65 Ref. Ref. 45–64 0.81 (0.59–1.12) 0.207 0.78 (0.57–1.09) 0.144 15–44 0.68 (0.51–0.90) 0.008 0.79 (0.57–1.09) 0.151 0–14 0.45 (0.13–1.58) 0.212 0.55 (0.17–1.85) 0.337 Time resident in UK+ UK-born Ref. Ref. ≥11 years 1.08 (0.81–1.44) 0.600 1.06 (0.76–1.47) 0.741 2–10 years 0.81(0.64–1.04) 0.105 0.81 (0.60–1.09) 0.161 <2 years 0.56 (0.39–0.79) 0.001 0.47 (0.32–0.67) <0.001 Area-level incidence Low/medium Ref. Ref. High 0.83 (0.59–1.17) 0.323 1.04 (0.73–1.47) 0.838 Referred by§ Primary care Ref. Ref. Secondary 0.65 (0.53–0.81) <0.001 0.63 (0.51–0.78) <0.001 Prison 0.53 (0.15–1.87) 0.323 0.61 (0.18–2.10) 0.432 Sputum smear Negative Ref. Ref. Positive 0.60 (0.49–0.74) <0.001 0.58 (0.47–0.70) <0.001 Social risk factors presentƒ None Ref. Ref. 1 0.71 (0.50–1.00) 0.05 0.91 (0.64–1.28) 0.578 ≥2 0.54 (0.34–0.86) 0.009 0.59 (0.38–0.94) 0.025 Bold type represents statistical significance at a p-value ≤0.05. #: all models include a random effect on 62 local authority districts; ¶: Wald p-value for overall effect of age group categorical variable crude 0.039, adjusted 0.40; +: Wald p-value for overall effect of time in UK categorical variable crude 0.002, adjusted <0.001; §: Wald p-value for overall effect of referred by categorical variable crude <0.001, adjusted <0.001; ƒ: Wald p-value for overall effect of social risk factor categorical variable crude 0.007, adjusted 0.08.
Supplementary Material
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Figures S1-S5 00161-2019.figures
Data sample cohort review form 00161-2019.form
Table S1-S5 00161-2019.tables
