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

OBJECTIVES: 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.

PATIENTS AND METHODS: 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.

RESULTS: 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 (= 0.006). Individuals living in one-person households had a 49% longer delay (= 0.047). Absence of chest pain was associated with shorter delay (-38%,= 0.032) and lower odds of extreme delay (odds ratio 0.39,= 0.047). Retired status independently predicted prolonged health system delay (42.1 days longer) and treatment delay (3.4 days longer).

CONCLUSION: 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.