J Korean Med Sci.  2022 Jan;37(3):e20. 10.3346/jkms.2022.37.e20.

Increased Healthcare Delays in Tuberculosis Patients During the First Wave of COVID-19 Pandemic in Korea: A Nationwide Cross-Sectional Study

• Min J
• Ko Y
• Kim HW
• Koo HK
• Oh JY
• Jeong YJ
• Kang HH
• Park KJ
• Hwang YI
• Kim JW
• Ahn JH
• Jegal Y
• Kang JY
• Lee SS
• Park JS
• Kim JS

• KMID: 2524889
• DOI: http://doi.org/10.3346/jkms.2022.37.e20

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems, consequently endangering tuberculosis (TB) control. We investigated delays in TB treatment among notified patients during the first wave of the COVID-19 pandemic in Korea.
Methods
We systemically collected and analyzed data from the Korea TB cohort database from January to May 2020. Groups were categorized as ‘before-pandemic’ and ‘during-pandemic’ based on TB notification period. Presentation delay was defined as the period between initial onset of symptoms and the first hospital visit, and healthcare delay as the period between the first hospital visit and anti-TB treatment initiation. A multivariate logistic regression analysis was performed to evaluate factors associated with delays in TB treatment.
Results
Proportion of presentation delay > 14 days was not significantly different between two groups (48.3% vs. 43.7%, P = 0.067); however, proportion of healthcare delay > 5 days was significantly higher in the during-pandemic group (48.6% vs. 42.3%, P = 0.012). In multivariate analysis, the during-pandemic group was significantly associated with healthcare delay > 5 days (adjusted odds ratio = 0.884, 95% confidence interval = 0.715–1.094).
Conclusion
The COVID-19 pandemic was associated with healthcare delay of > 5 days in Korea. Public health interventions are necessary to minimize the pandemic’s impact on the national TB control project.

Keyword

COVID-19; SARS-CoV-2; Tuberculosis; Healthcare; Diagnosis; Anti-Tuberculosis Treatment

Figure

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  Fig. 1 Flow chart of enrollment of tuberculosis patients before and during the COVID-19 pandemic.COVID-19 = coronavirus disease 2019.

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  Fig. 2 Box plots of tuberculosis care delays across the country before and during the COVID-19 pandemic. (A) Presentation delay. (B) Healthcare delays.The five regions with the most reported cases of COVID-19 were selected during early pandemic and re-categorized into two regions based on their proximity; Daegu-Gyeongbuk, and Seoul Metropolitan Area (Seoul, Incheon, and Gyeonggi), and both presentation and healthcare delays were also calculated in two regions.COVID-19 = coronavirus disease 2019.

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