Age-related patterns in delayed presentation and pre-hospital wound management for rabies post-exposure prophylaxis: a retrospective hospital-based study in Hangzhou, China, 2022–2025

Background Timely rabies post-exposure prophylaxis (PEP) and appropriate wound care are essential after potential rabies exposure, and older adults may face barriers to both. This study described presentation timing and pre-hospital wound management in a hospital-based cohort in Hangzhou, China. Methods This retrospective cross-sectional study included 3327 exposure-related clinic presentations between October 2022 and October 2025 after exclusion of 7 system-test entries, 15 WHO Category I exposures, 13 confirmed continuation visits, 10 contradictory-date records and 2 unresolved duplicate records. Subsequent-calendar-day presentation was a date-based operational proxy for delay. Separate multivariable logistic models evaluated presentation timing and any pre-hospital wound self-treatment. Results 218/3327 (6.6%) exposure-related presentations occurred on a subsequent calendar day. The clinic-opening calendar period (October–December 2022) was associated with subsequent-calendar-day presentation (AOR 2.54, 95% CI 1.63–3.96; P < 0.001), as was pre-hospital wound self-treatment (AOR 2.72, 95% CI 2.00–3.69; P < 0.001). Patients aged ≥ 65 years had higher adjusted odds of subsequent-calendar-day presentation than those aged 15–44 years (AOR 2.28, 95% CI 1.31–3.96; P = 0.003). The estimate for any self-treatment in the ≥ 65-year group was lower but did not reach the conventional significance threshold (AOR 0.71, 95% CI 0.50–1.01; P = 0.056). Conclusions In this hospital-based cohort, older age was associated with subsequent-calendar-day presentation. The estimate for lower self-treatment among older adults was imprecise and requires confirmation; the two outcomes were modelled separately and do not establish a combined individual-level outcome. Associations with the clinic-opening calendar period should be interpreted as exploratory because they may reflect clinic establishment, case mix, seasonality, or unmeasured access factors. Trial registration Clinical trial number: Not applicable.