LAUSR

Delay in diagnosing tuberculosis (TB) can result in greater morbidity, mortality, and exacerbates disease burden in underserved groups. Prompt diagnosis and treatment prevents transmission, so it is concerning that 59% of cases regionally started treatment >2 months after symptom onset in 2016 (Public Health England, TB in England 2017 Report). This project aimed to review Enhanced Surveillance System (ETS) data 2013-16 to describe socio-demographic factors contributing to diagnostic delay in Yorkshire & Humber (YH). Data on variables including sex, ethnicity, social risk factors, socio-economic status (SES) and smoking was extracted for all YH cases notified in 2013-16. Dependent variables comprised median time from symptom onset to: presentation to healthcare services (patient delay), and diagnosis and treatment start dates (healthcare system delay; HSD). Results were also stratified by place of birth and social risk factors. Of 1961 cases, median time to presentation was 31 days (IQR 7-74), time to diagnosis 82 days (41-148) and time to treatment start 84 days (44-153). Thus HSD comprised the majority of delay regionally. The median difference of 2 days between diagnosis and treatment start indicates treatment is commenced promptly after diagnosis. All delays were longer for women than men, smear-negative cases vs positive, and for smokers. Delays were also longer in areas of lower TB incidence. Cases with higher SES, and no social risk factors had longer delays. HSD was longer for non-UK born vs UK born, White vs Pakistani, and UK-born Whites vs non-UK born; likely reflecting lower clinical suspicion. Recommendations were made to decrease the disproportionate delay in the aforementioned populations regionally.