Median health care delay 24 days for tuberculosis patients in U.S.

The median health care delay for patients with tuberculosis (TB) in the United States is 24 days, according to a study published online March 23 in The Lancet Infectious Diseases.

Jessica El Halabi, M.D., from Harvard Medical School in Boston, and colleagues conducted a retrospective, observational cohort study measuring U.S. TB health care delays between 2008 and 2016 based on repurposed private insurance claims data (Aetna).

The researchers confirmed 738 active TB cases, which had a median health care delay of 24 days (interquartile range, 10 to 45 days). Longer delays correlated with older age (8.4 percent longer delay per 10-year increase in age) and with non-HIV immunosuppression (19.2 percent) in a multivariable analysis. Relative to presenting with one symptom, presenting with three or more symptoms correlated with shorter delays (−22.5 percent). Shorter delays were also seen in association with the use of chest imaging, a TB nucleic acid amplification test, or care by a TB specialist provider (−24.9, −19.2, and −17.2 percent, respectively). Even after adjustment for patient characteristics and a higher rate of secondary TB among dependents, longer delays correlated with a higher rate of respiratory complications.

"Our findings point to the key importance of continuing education of providers. We found several factors associated with delays and faster diagnosis," a coauthor said in a statement. "This tells us that delays are modifiable and preventable."

One author disclosed financial ties to Aetna; one disclosed ties to Aetna Life Insurance Company.

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