Impacts of the COVID-19 pandemic on tuberculosis patients' healthcare-seeking behaviors and doctors' diagnosis delays.

INTRODUCTION: Since the onset of the Corona Virus Disease 2019 (COVID-19) pandemic, global healthcare systems have faced unprecedented challenges. To control the spread of COVID-19, China implemented multiple nonpharmaceutical interventions (NPIs). These measures have significantly altered people's healthcare-seeking behaviors. This study aims to investigate the impact of the COVID-19 pandemic on healthcare-seeking behaviors and doctor s' diagnostic delays among pulmonary tuberculosis patients, providing systematic information for future responses to pandemics of other "X diseases". METHODS: We selected Changzhou and Suzhou as research sites in eastern China. Pulmonary tuberculosis patients diagnosed from 2018 to 2022 were recruited as study subjects. Based on the occurrence of the COVID-19 pandemic and the measures implemented at the study sites from 2020 to 2022, the study period was classified into the prepandemic, initial outbreak, regular management, strict NPI implementation, regular management, and transition periods. Patient and diagnosis delays were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to estimate the risk of delay using Cox regression models. RESULTS: A total of 6,764 tuberculosis patients from Changzhou and 15,140 tuberculosis patients from Suzhou who were diagnosed from 2018 to 2022 were included in the analysis. Compared with the prepandemic stage (2018-2020), the risk of patient delay did not decrease significantly during the pandemic of COVID-19 (P > 0.05), but the risk of diagnosis delay showed different trends at different stages throughout the pandemic. The risk of diagnosis delay decreased in Changzhou (HR: 1.18, 95% CI: 1.12-1.24), but it increased in Suzhou (HR: 0.92, 95% CI: 0.88-0.96). CONCLUSIONS: The impact of the COVID-19 pandemic on tuberculosis varied by region and population. It is necessary to respond in a timely and precise manner according to the scope of the disease pandemic, accessibility of medical resources, and population literacy to reduce the adverse impacts of other disease epidemics on tuberculosis prevention and control.