Delayed tuberculosis treatment in urban and suburban Ontario

Delay in the treatment of patients with tuberculosis (TB) increases the risk of poor clinical outcomes--including death and transmission of disease--and may be reducible.

To estimate delays in TB treatment in a Canadian, multicultural population and to examine factors associated with longer time to treatment.

Adult cases of active TB from January 1998 to December 2001 from the Ontario Reportable Disease Information System were included. Time to treatment was defined as the number of days between symptom onset and treatment.

Data from 1753 TB patients (76% of eligible patients) were analyzed. Median time to treatment was 62 days (interquartile range 31 to 114 days). Time periods longer than the median time to treatment were independently associated with middle-aged patients (OR 1.54, 95% CI 1.21 to 1.98), foreign-born patients who had lived in Canada for more than 10 years (OR 1.47, 95% CI 1.02 to 2.12), patients with nonpulmonary disease (OR 1.57, 95% CI 1.28 to 1.92) and patients managed within certain health districts.

A time to TB treatment of two months or more is common in Ontario, and associated with several factors. Future studies are needed to build on these findings to decrease delay and improve individual and public health outcomes.