Author(s): Moniz, Marta ; Soares, Patrícia ; Leite, Andreia ; Nunes, Carla
Date: 2021
Persistent ID: http://hdl.handle.net/10362/125827
Origin: Repositório Institucional da UNL
Subject(s): Diagnosis delay; Foreign-born; Risk factors; Tuberculosis; Infectious Diseases; SDG 3 - Good Health and Well-being
Funding Information: The study was supported by the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal (PTDC/SAU-PUB/31346/2017). Publisher Copyright: © 2021, The Author(s).
Background: Delay in Tuberculosis (TB) diagnosis affects foreign-born and nationals in different ways, especially in low-incidence countries. This study characterises total delay and its components amongst foreign-born individuals in Portugal. Additionally, we identify risk factors for each type of delay and compare their effects between foreign-born and nationals. Methods: We analysed data from the Portuguese TB surveillance system and included individuals with pulmonary TB (PTB), notified between 2008 and 2017. We described patient, healthcare, and total delays. Cox regression was used to identify factors associated with each type of delay. All analyses were stratified according to the origin country: nationals (those born in Portugal) and foreign-born. Results: Compared with nationals, foreign-born persons presented statistically significant and longer median total and patient delays (Total: 67 vs. 63; Patient: 44 vs. 36 days), and lower healthcare services delays (7 vs. 9 days). Risk factors for delayed diagnosis differed between foreign-born and nationals. Being unemployed, having drug addiction, and having comorbidities were identified as risk factors for delayed diagnosis in national individuals but not in foreigners. Alcohol addiction was the only factor identified for healthcare delay for both populations: foreign-born (Hazard Ratio 1.34 [95% confidence interval 1.17;1.53]); nationals (Hazard Ratio 1.20 [95% confidence interval 1.13;1.27]). Conclusions: Foreign-born individuals with PTB take longer to seek health care. While no specific risk factors were identified, more in-depth studies are required to identify barriers and support public health intervention to address PTB diagnosis delay in foreign-born individuals.
