Factors associated with delay in diagnosis among tuberculosis patients in the north of Iran

  • Mahmood Moosazadeh Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran; Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Science, Sari, Iran https://orcid.org/0000-0002-5452-514X
  • Motahareh Kheradmand Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Science, Sari, Iran https://orcid.org/0000-0002-4843-302X
  • Mohsen Aarabi Department of Family Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
  • Mahdi Afshari Department of Community Medicine, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran https://orcid.org/0000-0002-3159-8741
  • Mohammadreza Parsaee Mazandaran University of Medical Sciences, Sari, Iran
  • Asghar Nezammahalleh Mazandaran University of Medical Sciences, Sari, Iran
  • Amirhossein Hessami Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran https://orcid.org/0000-0002-1219-1081
Keywords: delayed diagnosis, Iran, tuberculosis
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BACKGROUND Recognizing factors that affect delay in diagnosis in patients with pulmonary tuberculosis (TB) is critical. This study aimed to identify such factors among TB patients in the north of Iran.

METHODS In this retrospective cohort study, we reviewed patient’s medical records from the TB registration system of the Health Deputy of Mazandaran University of Medical Sciences, Sari, Iran that was responsible for the TB registry in the province from 2007 to 2017. All hospitals affiliated with the university, including private hospitals, reported TB cases directly to the health deputy. Patient’s gender, age, TB smear result, TB type, imprisonment, diabetes, nationality, residence area, and drug use were considered factors of delay in diagnosis, which was defined as a delay of >30 days between symptom onset and diagnosis. Data from 3,453 patients were analyzed using the chi-square test and logistic regression models.

RESULTS The frequency of patients with delay in diagnosis was 67.7%. There was no association between delay in diagnosis and gender (p = 0.194), TB type (p = 0.140), and diabetes (p = 0.198). On the other hand, old age (≥60 years) was related to delay in diagnosis (OR = 1.37; 95% CI = 1.12–1.68; p = 0.002). The chance of delay in diagnosis in prisoners was lower than in non-prisoners (OR = 0.62; 95% CI = 0.46–0.82; p = 0.001).

CONCLUSIONS Old age was a risk factor for delay in diagnosis, and interestingly, prisoners had been diagnosed significantly faster.


  1. World Health Organization. Global tuberculosis report 2017. Geneva: World Health Organization; 2017.

  2. Nasehi MM, Moosazadeh M, Amiresmaeili MR, Parsaee MR, Nezammahalleh A. The epidemiology of factors associated with screening and treatment outcomes of patients with smear positive pulmonary tuberculosis: a population-based study. J Mazandaran Univ Med Sci. 2012;21(1):9-18.

  3. Bogale S, Diro E, Shiferaw AM, Yenit MK. Factors associated with the length of delay with tuberculosis diagnosis and treatment among adult tuberculosis patients attending at public health facilities in Gondar town, Northwest, Ethiopia. BMC Infect Dis. 2017;17:145. https://doi.org/10.1186/s12879-017-2240-0

  4. Lin Y, Enarson DA, Chiang CY, Rusen ID, Qiu LX, Kan XH, et al. Patient delay in the diagnosis and treatment of tuberculosis in China: findings of case detection projects. Public Health Action. 2015;5(1):65-9. https://doi.org/10.5588/pha.14.0066

  5. Mekonnen YA, Abebe L, Fentahun N, Belay SA, Kassa AW. Delay for first consultation and associated factors among tuberculosis patients in Bahir Dar town administration, North West Ethiopia. Am J Health Res. 2014;2(4):140-5. https://doi.org/10.11648/j.ajhr.20140204.16

  6. Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. 2008;8:15. https://doi.org/10.1186/1471-2458-8-15

  7. Getnet F, Demissie M, Assefa N, Mengistie B, Worku A. Delay in diagnosis of pulmonary tuberculosis in low-and middle-income settings: systematic review and meta-analysis. BMC Pulm Med. 2017;17:202. https://doi.org/10.1186/s12890-017-0551-y

  8. Sreeramareddy CT, Panduru KV, Menten J, Van den Ende J. Time delays in diagnosis of pulmonary tuberculosis: a systematic review of literature. BMC Infect Dis. 2009;9:91. https://doi.org/10.1186/1471-2334-9-91

  9. Loutet MG, Sinclair C, Whitehead N, Cosgrove C, Lalor MK, Thomas HL. Delay from symptom onset to treatment start among tuberculosis patients in England, 2012-2015. Epidemiol Infect. 2018;146(12):1511-8. https://doi.org/10.1017/S095026881800167X

  10. Alavi SM, Bakhtiyariniya P, Albagi A. Factors associated with delay in diagnosis and treatment of pulmonary tuberculosis. Jundishapur J Microbiol. 2015;8(3):e19238. https://doi.org/10.5812/jjm.19238

  11. Alipour N, Sheikhi M, Yazdani Charati J, Mohsenipouya H, Shabankhani B, Rezaii MS. Total delay and associated factors in pulmonary tuberculosis patients in Golestan province. Caspian J Intern Med. 2020;11(1):67-74. https://doi.org/10.22088/cjim.11.1.67

  12. Ali U, Zubair UB, Ambreen A, Yousaf H, Kaleem F, Khalil KF. Delay in diagnosis of pulmonary tuberculosis: study of factors related to patients and health care system. J Microbiol Infect Dis. 2017;7(3):119-24. https://doi.org/10.5799/jmid.367424

  13. Ben Amar J, Hassairi M, Ben Salah N, Charfi R, Tritar F, Fourati R, et al. Pulmonary tuberculosis: diagnostic delay in Tunisia. Med Mal Infecti. 2016;46(2):79-86. https://doi.org/10.1016/j.medmal.2015.11.012

  14. Li Y, Ehiri J, Tang S, Li D, Bian Y, Lin H, et al. Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis. BMC Med. 2013;11:156. https://doi.org/10.1186/1741-7015-11-156

  15. Nasehi M, Hassanzadeh J, Rezaianzadeh A, Zeigami B, Tabatabaee H, Ghaderi E. Diagnosis delay in smear positive tuberculosis patients. J Res Med Sci. 2012;17(11):1001-4.

  16. Said K, Hella J, Mhalu G, Chiryankubi M, Masika E, Maroa T, et al. Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania. Infect Dis Poverty. 2017;6:64. https://doi.org/10.1186/s40249-017-0276-4

  17. Buregyeya E, Criel B, Nuwaha F, Colebunders R. Delays in diagnosis and treatment of pulmonary tuberculosis in Wakiso and Mukono districts, Uganda. BMC Public Health. 2014;14:586. https://doi.org/10.1186/1471-2458-14-586

  18. Johansson E, Long NH, Diwan VK, Winkvist A. Gender and tuberculosis control: perspectives on health seeking behaviour among men and women in Vietnam. Health Policy. 2000;52(1):33-51. https://doi.org/10.1016/S0168-8510(00)00062-2

  19. Shu W, Chen W, Zhu S, Hou Y, Mei J, Bai L, et al. Factors causing delay of access to tuberculosis diagnosis among new, active tuberculosis patients: a prospective cohort study. Asia Pac J Public Health. 2014;26(1):33-41. https://doi.org/10.1177/1010539513502523

  20. Das S, Basu M, Mandal A, Roy N, Chatterjee S, Dasgupta A. Prevalence and determinants of delay in diagnosis of pulmonary tuberculosis in Darjeeling district of West Bengal. J Family Med Prim Care. 2017;6(3):627-35. https://doi.org/10.4103/2249-4863.214432

  21. Narasimhan P, Wood J, MacIntyre CR, Mathai D. Risk factors for tuberculosis. Pulmonary medicine. 2013;2013:828939. https://doi.org/10.1155/2013/828939

  22. Babamahmoodi F, Alikhani A, Yazdani Charati J, Ghovvati A, Ahangarkani F, Delavarian L, et al. Clinical epidemiology and paraclinical findings in tuberculosis patients in north of Iran. Biomed Res Int. 2015;2015:381572. https://doi.org/10.1155/2015/381572

  23. Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5(7):e152. https://doi.org/10.1371/journal.pmed.0050152

  24. Al-Rifai RH, Pearson F, Critchley JA, Abu-Raddad LJ. Association between diabetes mellitus and active tuberculosis: a systematic review and meta-analysis. PLoS One. 2017;12(11):e0187967. https://doi.org/10.1371/journal.pone.0187967

  25. Lee EH, Lee JM, Kang YA, Leem AY, Kim EY, Jung JY, et al. Prevalence and impact of diabetes mellitus among patients with active pulmonary tuberculosis in South Korea. Lung. 2017;195(2):209-15. https://doi.org/10.1007/s00408-017-9978-4

  26. Chen HG, Liu M, Jiang SW, Gu FH, Huang SP, Gao TJ, et al. Impact of diabetes on diagnostic delay for pulmonary tuberculosis in Beijing. Int J Tuberc Lung Dis. 2014;18(3):267-71. https://doi.org/10.5588/ijtld.13.0140

  27. Htun YM, Khaing TM, Yin Y, Myint Z, Aung ST, Hlaing TM, et al. Delay in diagnosis and treatment among adult multidrug resistant tuberculosis patients in Yangon Regional Tuberculosis Center, Myanmar: a cross-sectional study. BMC Health Serv Res. 2018;18(1):878. https://doi.org/10.1186/s12913-018-3715-4

  28. Deiss RG, Rodwell TC, Garfein RS. Tuberculosis and illicit drug use: review and update. Clin Infect Dis. 2009;48(1):72-82. https://doi.org/10.1086/594126

  29. Deponti GN, Silva DR, Coelho AC, Muller AM, Dalcin Pde T. Delayed diagnosis and associated factors among new pulmonary tuberculosis patients diagnosed at the emergency department of a tertiary care hospital in Porto Alegre, South Brazil: a prospective patient recruitment study. BMC Infect Dis. 2013;13:538. https://doi.org/10.1186/1471-2334-13-538

  30. Oeltmann JE, Kammerer JS, Pevzner ES, Moonan PK. Tuberculosis and substance abuse in the United States, 1997-2006. Arch Intern Med. 2009;169(2):189-97. https://doi.org/10.1001/archinternmed.2008.535

  31. Abarca Tomás B, Pell C, Bueno Cavanillas A, Guillén Solvas J, Pool R, Roura M. Tuberculosis in migrant populations. A systematic review of the qualitative literature. PLoS One. 2013;8(12):e82440. https://doi.org/10.1371/journal.pone.0082440

How to Cite
Moosazadeh M, Kheradmand M, Aarabi M, Afshari M, Parsaee M, Nezammahalleh A, Hessami A. Factors associated with delay in diagnosis among tuberculosis patients in the north of Iran. Med J Indones [Internet]. 2021Mar.25 [cited 2021Jun.21];30(1):60-5. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/4476
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