Rural Residence and One-Person Households Are Associated with Diagnostic Delay in Pulmonary Tuberculosis in a Low-Incidence European Setting.

Diagnostic delay in pulmonary tuberculosis remains a significant barrier to effective disease control, even in low-incidence settings. This study aimed to identify factors associated with total delay and its components among adults with pulmonary tuberculosis in such a setting. A retrospective observational study was conducted on adults with pulmonary tuberculosis treated at a tuberculosis care centre in Croatia. Total delay was defined as the interval between symptom onset and treatment initiation. Data were collected through structured patient interviews using a standardized questionnaire, medical record review, and routine tuberculosis notification forms from the national public health registry. Sociodemographic and clinical predictors were evaluated using multivariable linear and logistic regression analyses. Among 116 participants, the median total delay was 85 days (interquartile range 48.5-155.3). Rural residence was the strongest independent predictor, with patients experiencing an 88% longer delay than urban residents (p = 0.006). Individuals living in one-person households had a 49% longer delay (p = 0.047). Absence of chest pain was associated with shorter delay (-38%, p = 0.032) and lower odds of extreme delay (odds ratio 0.39, p = 0.047). Retired status independently predicted prolonged health system delay (42.1 days longer) and treatment delay (3.4 days longer). Prolonged delay may become increasingly important in the context of population ageing and changing household structures. Targeted strategies focused on rural, retired, and people living in one-person households may improve the timeliness of tuberculosis detection in settings where declining incidence can reduce clinical suspicion.