关键词: 传染病, 布鲁杆菌病, 延迟诊断, 影响因素分析, 问卷调查

Abstract: Background　Early detection of cases, early diagnosis and early standardized treatment are key to controlling human brucellosis and prevent its chronic development. It is important to study the causes and influencing factors of delayed detection of brucellosis by stages for comprehensive measures, targeted prevention and control of brucellosis. Objective　To study factors influencing delay in visit and diagnosis of human brucellosis, and provide basis for targeted risk control.Methods　Patients with brucellosis reported in Tianjin from 2012 to 2017 were selected as the research object.Self-designed questionnaires were used to collect the data of patients' gender, age, occupation, residence, clinical symptoms and signs, the name of diagnostic disease, the type of preferred hospital, the location of preferred hospital, the clinical stages at the time of consultation, and the first-visit department. According to whether the patient had delay in visit or initial diagnosis, they were divided into the timely visit group, the delayed visit group, the timely initial diagnosis and the delayed initial diagnosis group. Logistic regression was used to analyze the influencing factors of delayed visit and initial diagnosis. Results　A total of 808 cases with brucellosis were investigated. The delayed visit rate was 34.8%（281/808） and the delayed rate of initial diagnosis was 60.9%（492/808）．There were significant differences in fever, preferred hospital type and preferred hospital location between delayed visit group and timely visit group（P<0.05）．Multivariate Logistic regression analysis showed that the type of preferred hospital〔OR=1.70，95%CI（1.48，1.97）〕, the location of preferred hospital〔OR=1.25，95%CI（1.04，1.49）〕were the influencing factors of delay（P<0.05）．There were significant differences in occupation, residence, type of first-visit hospital, location of first-visit hospital, clinical stage and first-visit department between the timely initial diagnosis and the delayed initial diagnosis group（P<0.05）．Multivariate Logistic regression analysis showed that residence 〔OR=1.53，95%CI（1.11，2.10）〕, type of first-visit hospital〔OR=1.37，95%CI（1.24，1.51）〕, first-visit department〔OR=1.55，95%CI（1.39，1.73）〕were the influencing factors of delay in initial diagnosis（P<0.05）．Conclusion　Patients with brucellosis have different degrees of delay in the visit and diagnosis. To reduce the detection delay, we should focus on reducing the first diagnosis delay. Residence, type of preferred hospital and first-visit department may be the factors influencing the delay of first-time diagnosis of brucellosis.

Key words: Communicable diseases, Brucellosis, Delayed diagnosis, Root cause analysis, Questionnaires