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

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
  • 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
  • 5Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
  • 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
  • 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
  • 8Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
  • 9Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
  • 10Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 11Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 12Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea

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

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

  • 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.


Cited by  1 articles

To Prescribe, or Not to Prescribe, That Is the Question
Chin Kook Rhee
J Korean Med Sci. 2022;37(29):e240.    doi: 10.3346/jkms.2022.37.e240.


Reference

1. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 5. Updated 2020. Accessed September 17, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 .
2. Oh J, Lee JK, Schwarz D, Ratcliffe HL, Markuns JF, Hirschhorn LR. National response to COVID-19 in the Republic of Korea and lessons learned for other countries. Health Syst Reform. 2020; 6(1):e1753464. PMID: 32347772.
Article
3. Alene KA, Wangdi K, Clements AC. Impact of the COVID-19 pandemic on tuberculosis control: an overview. Trop Med Infect Dis. 2020; 5(3):123.
Article
4. Min J, Kim HW, Ko Y, Oh JY, Kang JY, Lee J, et al. Tuberculosis surveillance and monitoring under the national public-private mix tuberculosis control project in South Korea 2016–2017. Tuberc Respir Dis (Seoul). 2020; 83(3):218–227.
Article
5. Son E, Jeon D. Current situation of tuberculosis and national strategic plan for tuberculosis control in Korea. J Korean Med Assoc. 2021; 64(4):316–323.
Article
6. Yang J, Kwon Y, Kim J, Jang Y, Han J, Kim D, et al. Delays in the diagnosis and treatment of tuberculosis during the COVID-19 outbreak in the Republic of Korea in 2020. Osong Public Health Res Perspect. 2021; 12(5):293–303. PMID: 34719221.
Article
7. Kang YJ. Characteristics of the COVID-19 outbreak in Korea from the mass infection perspective. J Prev Med Public Health. 2020; 53(3):168–170. PMID: 32498139.
Article
8. Korean Society of Infectious Diseases. Korean Society of Pediatric Infectious Diseases. Korean Society of Epidemiology. Korean Society for Antimicrobial Therapy. Korean Society for Healthcare-associated Infection Control and Prevention. Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci. 2020; 35(10):e112. PMID: 32174069.
9. World Health Organization. Global Tuberculosis Report 2020. Geneva, Switzerland: World Health Organization;2020.
10. Min J, Kang JY, Kim J, Yang J, Kwon Y, Shim E, et al. Impact of COVID-19 on TB services in Korea. Int J Tuberc Lung Dis. 2021; 25(5):400–402. PMID: 33977909.
Article
11. Di Gennaro F, Gualano G, Timelli L, Vittozzi P, Di Bari V, Libertone R, et al. Increase in tuberculosis diagnostic delay during first wave of the COVID-19 pandemic: data from an Italian Infectious Disease Referral Hospital. Antibiotics (Basel). 2021; 10(3):272. PMID: 33800406.
Article
12. Kim SH, Min J, Cho JY, Kang H, Yang B, Shin YM, et al. Clinical profiles and outcomes of pulmonary tuberculosis patients with delayed treatment at a tertiary hospital in South Korea. Ann Palliat Med. 2021; 10(3):2948–2957. PMID: 33691443.
Article
13. Yoo KJ, Kwon S, Choi Y, Bishai DM. Systematic assessment of South Korea’s capabilities to control COVID-19. Health Policy. 2021; 125(5):568–576. PMID: 33692005.
Article
14. Kwon KT, Ko JH, Shin H, Sung M, Kim JY. Drive-through screening center for COVID-19: a safe and efficient screening system against massive community outbreak. J Korean Med Sci. 2020; 35(11):e123. PMID: 32193904.
Article
15. Kwak N, Hwang SS, Yim JJ. Effect of COVID-19 on Tuberculosis Notification, South Korea. Emerg Infect Dis. 2020; 26(10):2506–2508. PMID: 32672531.
Article
16. Jeong HE, Lee J, Shin HJ, Shin JY. Socioeconomic disparities in Korea by health insurance type during the COVID-19 pandemic: a nationwide study. Epidemiol Health. 2021; 43(0):e2021007. PMID: 33445821.
Article
17. Yoon WH. Why fast COVID-19 vaccination needed for people with disabilities and autistics in Korea? J Korean Med Sci. 2021; 36(37):e267. PMID: 34581522.
Article
18. Min J, Kim HW, Koo HK, Ko Y, Oh JY, Kim J, et al. Impact of COVID-19 pandemic on the national PPM tuberculosis control project in Korea: the Korean PPM monitoring database between July 2019 and June 2020. J Korean Med Sci. 2020; 35(43):e388. PMID: 33169559.
Article
19. Glaziou P. Predicted impact of the COVID-19 pandemic on global tuberculosis deaths in 2020. medRxiv. May. 04. 2020; DOI: 10.1101/2020.04.28.20079582.
Article
20. Wang X, He W, Lei J, Liu G, Huang F, Zhao Y. Impact of COVID-19 pandemic on pre-treatment delays, detection, and clinical characteristics of tuberculosis patients in Ningxia Hui Autonomous Region, China. Front Public Health. 2021; 9:644536. PMID: 34095053.
Article
21. Bonadonna LV, Saunders MJ, Zegarra R, Evans C, Alegria-Flores K, Guio H. Why wait? The social determinants underlying tuberculosis diagnostic delay. PLoS One. 2017; 12(9):e0185018. PMID: 28945782.
Article
22. Saunders MJ, Evans CA. COVID-19, tuberculosis and poverty: preventing a perfect storm. Eur Respir J. 2020; 56(1):2001348. PMID: 32444399.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr