Factors related to patient delay in pulmonary tuberculosis in Estonia

The resurgence of tuberculosis (TB) in Estonia, a post-socialist Eastern European country, has coincided with delayed case detection suggested by increase in advanced forms of pulmonary tuberculosis among newly detected cases. We estimated the determinants of patient delay in conditions of negligible HIV infection, insignificant immigration and free access to medical care with TB. All newly-detected symptomatic culture-positive patients aged > or =16 y with pulmonary TB from southern Estonia during 2002-2003 (n=185) were interviewed. Intervals greater than the median (79 d) and the 75th percentile (140 d) between onset of the first symptom and the first medical visit were defined as prolonged and extreme patient delay, respectively. Male gender was associated with both prolonged and extreme patient delay (OR 2.12; 95% CI 1.06-4.23 and OR 3.28; 95% CI 1.30-8.26, respectively), whereas rural residence was associated with prolonged patient delay (OR 2.08; 95% CI 1.06-4.08). Median patient delay was shortest when the first symptom was fever (22 d) and greatest when it was cough with haemoptysis (196 d). The study shows that even in absence of barriers in accessing health care, the median patient delay can be longer than in most former studies, whereas males and rural residents are at greater risk.