Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France

Int J Tuberc Lung Dis. 2012 Apr;16(4):510-5. doi: 10.5588/ijtld.11.0420.


Objective: To analyse diagnostic delay in tuberculosis (TB) patients.

Design: Cross-sectional study: all patients with TB notified to the French national surveillance system from April to June 2010 were interviewed face-to-face using a standardised questionnaire to assess symptom history and health-seeking trajectories.

Results: Of 225 patients enrolled, 172 (76.4%) had pulmonary TB, including 88 who were smear-positive. Mean delay between first symptoms and diagnosis (total delay) was 97 days (median 68, IQR 33-111), with a mean of 47 days (median 14, IQR 0-53) between first symptoms and health care contact (patient delay), and 48 days (median 25, IQR 6-67) between health care contact and diagnosis (health system delay). Factors independently associated with shortened total delay were medical insurance (OR 0.24, P = 0.014) and previous TB (OR 0.28, P = 0.049). Those associated with reduced patient delay were initial fever (OR 0.42, P = 0.03) and being followed by a general practitioner (OR 0.22, P = 0.004), while those associated with reduced health system delay were first health care contact within a hospital (OR 0.15, P < 0.001). Empirical antibiotic treatment was associated with increased health system delay (OR 4.4, P = 0.001).

Conclusion: TB diagnostic delay needs to be reduced in France. This may be achieved through improved access to care, earlier hospital referral, and less use of empirical antibiotic treatment.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Cross-Sectional Studies
  • Delayed Diagnosis*
  • Female
  • France
  • Health Services Accessibility*
  • Humans
  • Male
  • Middle Aged
  • Population Surveillance
  • Prospective Studies
  • Referral and Consultation
  • Sputum / microbiology
  • Surveys and Questionnaires
  • Time Factors
  • Tuberculosis / diagnosis*
  • Tuberculosis, Pulmonary / diagnosis
  • Young Adult


  • Anti-Bacterial Agents