Social Determinants of Delayed Diagnosis of Tuberculosis in a North China Urban Setting

A quantitative/qualitative mixed methodology was used to investigate treatment delay and determine social determinants of TB among 70 pulmonary TB patients in China. Median total diagnostic delay (TDD) time was 4 weeks for men and 5 weeks for women; 25% of patients experienced a TDD of 20 or more weeks. Seventy-six percent of patients who had a delay of more than 2 weeks attributed the delay to their own personal lack of awareness. Fifty-seven percent of the population reported experiencing more than one of the four common TB symptoms, and 30% reported experiencing three or more symptoms. Patients' qualitative descriptions of the process from onset of symptoms to diagnosis of TB described a circuitous and imprecise one. Delay in seeking treatment among TB patients in China is prolonged because of both personal and systemic reasons. It is essential that diagnostic delay be understood and reduced to decrease the burden of disease globally.