Health seeking behaviour and diagnostic delays in SLE: A multi-ethnic Malaysian cohort study.

IF 1.9 4区 医学 Q3 RHEUMATOLOGY
Lupus Pub Date : 2024-11-07 DOI:10.1177/09612033241297548
Fatimah Zanirah Nordin, Syahrul Sazliyana Shaharir, Mohd Shahrir Mohamed Said, Rozita Mohd, Rajalingham Sakthiswary, Tengku Amatullah Madeehah Tengku Mohd, Mohd Hafiz Jaafar, Wong Chin Yew
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引用次数: 0

Abstract

Introduction: Heterogeneity of the clinical manifestations of systemic lupus erythematosus (SLE) may lead to diagnostic delays. This study is aimed at determining the health-seeking behaviour patterns and factors associated with diagnostic delays in a multi-ethnic SLE cohort in Malaysia.

Methodology: This was a cross-sectional study involving SLE patients who visited our institute between January 2020 and June 2021. A review of the medical records and face-to-face interviews were conducted to obtain sociodemographics, SLE disease characteristics and the intervals from the first symptoms to the diagnosis. Health-seeking behaviours were assessed by asking about the patients' first action during the initial symptoms and were divided into: (i) seeking professional health personnel; (ii) self-treatment; and (iii) the use of the internet as a primary source of information. Diagnostic delays were defined as the interval between initial symptoms and SLE diagnosis of more than 6 months. Low-level disease activity state (LLDAS) at 12 months was assessed from the medical records. Univariate and multivariate logistic regression analysis was subsequently conducted to determine factors associated with diagnostic delays.

Results: Among the 154 patients included in the study, 24% (n = 37) had delayed diagnosis. The delay was significantly higher among the Indian versus Malay versus Chinese (42.9% vs 28% vs 10.8%, p = 0.037). Patients with rash tend to have delayed diagnosis (37.8% vs 22.2%, p = 0.08) while fewer patients with frothy urine had delayed diagnosis (8.1% vs 21.4%, p = 0.09). No significant association was found between health-seeking behaviours and diagnostic delays. The rate of LLDAS at 12 months was significantly lower among patients with delayed diagnosis (43.2% vs 70.0%, p = 0.006). Chinese ethnicity remained the only significant factor associated with lesser diagnostic delays in the multivariate analysis, with OR 0.30 (CI 0.09-0.93), p = 0.037.

Conclusion: There were ethnic disparities in the early diagnosis of SLE in Malaysia, with Indian patients having a longer interval between the first symptom and diagnosis while the Chinese were associated with lower diagnostic delays. Early diagnosis predicted early attainment of LLDAS, suggesting that prompt recognition of the initial SLE symptoms is important.

系统性红斑狼疮的就医行为与诊断延误:一项马来西亚多种族队列研究。
导言:系统性红斑狼疮(SLE)临床表现的异质性可能会导致诊断延误。本研究旨在确定马来西亚多种族系统性红斑狼疮患者的就医行为模式以及与诊断延误相关的因素:这是一项横断面研究,涉及在 2020 年 1 月至 2021 年 6 月期间到我院就诊的系统性红斑狼疮患者。研究人员查阅了患者的病历并进行了面对面的访谈,以了解患者的社会人口学特征、系统性红斑狼疮疾病特征以及从首次出现症状到确诊的时间间隔。通过询问患者在最初出现症状时采取的第一项行动来评估其寻求健康的行为,并将其分为:(i) 寻求专业医护人员;(ii) 自我治疗;(iii) 使用互联网作为主要信息来源。诊断延迟是指从最初出现症状到确诊系统性红斑狼疮之间的时间间隔超过 6 个月。12个月时的低水平疾病活动状态(LLDAS)是根据病历进行评估的。随后进行了单变量和多变量逻辑回归分析,以确定与诊断延迟相关的因素:在纳入研究的 154 名患者中,24%(n = 37)的患者诊断延误。印度人与马来人、华人相比,延误率明显更高(42.9% vs 28% vs 10.8%,P = 0.037)。有皮疹的患者往往被延迟诊断(37.8% vs 22.2%,p = 0.08),而有泡沫尿的患者被延迟诊断的比例较低(8.1% vs 21.4%,p = 0.09)。在求医行为和诊断延误之间没有发现明显的关联。延迟诊断的患者在12个月后的LLDAS率明显较低(43.2% vs 70.0%,p = 0.006)。在多变量分析中,华裔仍是唯一与较少诊断延迟相关的重要因素,OR 为 0.30 (CI 0.09-0.93),P = 0.037:在马来西亚,系统性红斑狼疮的早期诊断存在种族差异,印度患者从首次出现症状到确诊的间隔时间较长,而华人的诊断延迟时间较短。早期诊断预示着 LLDAS 的早期达标,这表明及时识别最初的系统性红斑狼疮症状非常重要。
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来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
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