Risk Factors Associated With Tuberculosis Diagnostic Delay in the Jiangsu Province, China (2011-2021): Spatiotemporal...

Tuberculosis (TB) remains a major public health concern. Despite improved diagnostic tools, delays in TB diagnosis persist and hinder control efforts.

This study aims to investigate the spatiotemporal patterns of TB diagnostic delay and identify individual and spatial risk factors in Jiangsu Province, China, from 2011 to 2021.

This study included 332,091 patients with TB who reported in Jiangsu Province from 2011 to 2021, using data obtained from the Jiangsu TB Information Management System, and diagnostic delay was defined as an interval of more than 28 days between symptom onset and diagnosis. Logistic regression was used to evaluate individual-level factors associated with delayed status, while a Bayesian spatiotemporal Beta model was used to analyze county-level TB diagnostic delay rates and assess spatial correlation using the global Moran I. The panel Granger causality analysis explored the temporal dynamics of delay rate transitions.

Male patients, educators, and those diagnosed at the local Centers for Disease Control and Prevention had lower odds of diagnostic delay, whereas the older adults, agricultural workers, migrants, clinically diagnosed cases, and those diagnosed at community health centers had higher odds of delay. Spatial clustering in TB diagnostic delay rates was significant from 2015 onward (Moran I=0.110-0.193; all P<.05), excluding 2018 when Moran I was 0.054. The Bayesian spatiotemporal Beta model, which accounted for 31.8% of the total variation due to spatial structure, indicated that for each 1-unit increase in the proportion of local patients and for each 100,000-person increase in resident population, the TB diagnostic delay rate decreased by 33.9% (95% CI 0.128-0.498) and 2% (95% CI 0.005-0.033), respectively. The panel Granger causality analysis indicated that TB incidence and health care technicians significantly influenced temporal changes in delay rates.

TB diagnostic delays in Jiangsu were influenced by both individual and spatial factors, with the proportion of local patients and resident population size contributing significantly to spatiotemporal variation. Tailored interventions targeting high-risk groups and health care settings are needed.