Disparities in tuberculosis diagnostic delays between native and migrant populations in Italy: A multicenter study

IF 4.8 2区医学 Q1 INFECTIOUS DISEASES International Journal of Infectious Diseases Pub Date : 2024-10-28 DOI:10.1016/j.ijid.2024.107279

Francesco Di Gennaro , Sergio Cotugno , Giacomo Guido , Francesco Cavallin , Mariantonietta Pisaturo , Lorenzo Onorato , Federica Zimmerhofer , Luca Pipitò , Giuseppina De Iaco , Giuseppe Bruno , Massimo Fasano , Agostina Pontarelli , Annarita Botta , Tiziana Iacovazzi , Rossana Lattanzio , Virginia Di Bari , Gianfranco Panico , Raffaella Libertone , Caterina Monari , Alessia Musto , Annalisa Saracino

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Abstract

Background

Tuberculosis (TB) remains a Global Health challenge, with diagnostic delays contributing significantly to its spread. This study investigates the differences in diagnostic delays between native and migrant TB patients in Italy, examining patient-related diagnostic delay (PDD), health system-related diagnostic delay (HDD), and total diagnostic delay (TDD).

Methods

We conducted a retrospective, multicenter, cross-sectional study of TB cases in 10 Italian hospitals from 2018 to 2023. We compared PDD, HDD, and TDD between native and migrant populations. Socio-demographic data and clinical histories were analyzed to identify factors contributing to diagnostic delays.

Results

We included 669 TB patients (390 migrants and 279 natives). Migrants experienced significantly longer PDD (median 90 vs 10 days, P < 0.0001) but shorter HDD (median 5 vs 40 days, P < 0.0001) compared to natives, resulting in a longer TDD (median 96 vs 65 days, P < 0.0001). Furthermore, migrants had higher Timika scores, longer sputum conversion times, and were more frequently lost to follow-up.

Conclusion

Migrants face longer PDD, emphasizing substantial barriers to healthcare access. Natives experience longer HDD, reflecting neglect of TB in low-endemic regions. Future research should focus on the impact of social determinants and training for healthcare providers on TB diagnosis and develop strategies to reduce diagnostic delays.

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意大利本土人口与移民人口结核病诊断延迟的差异：一项多中心研究。

背景：结核病（TB）仍然是全球健康面临的一项挑战，诊断延误在很大程度上导致了结核病的传播。本研究调查了意大利本土肺结核患者和移民肺结核患者在诊断延误方面的差异，考察了与患者相关的诊断延误（PDD）、与医疗系统相关的诊断延误（HDD）和总诊断延误（TDD）：我们对 2018 年至 2023 年意大利 10 家医院的结核病例进行了一项回顾性、多中心、横断面研究。我们比较了本地人口和移民人口的 PDD、HDD 和 TDD。我们分析了社会人口学数据和临床病史，以确定导致诊断延误的因素：我们纳入了 669 名肺结核患者（390 名移民和 279 名本地人）。结果：我们纳入了 669 名肺结核患者（390 名移民和 279 名本地人），其中移民的肺结核诊断延误时间明显更长（中位数 90 天对 10 天，P移民面临更长的肺结核病期，强调了获得医疗服务的巨大障碍。本地人则经历了更长的 HDD，这反映了低流行地区对结核病的忽视。未来的研究应关注社会决定因素和医疗服务提供者培训对结核病诊断的影响，并制定减少诊断延误的策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.