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Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Median patient, healthcare and total delays was 37\u2009days (Interquartile range (IQR): 19\u201371), 8\u2009days (IQR: 1\u201332) and 62\u2009days (IQR: 38\u2013102), respectively.<\/jats:p>\n                <jats:p>The median patient delay showed a constant increase, from 33\u2009days in 2008 to 44\u2009days in 2017. The median total delay presented a similar trend, increasing from 59\u2009days in 2008 to 70\u2009days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay &gt;\u20091\u2009month between symptom onset and diagnosis.<\/jats:p>\n                <jats:p>In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45\u2009years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45\u2009years and being from a high TB incidence country were associated with longer total delay.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study.<\/jats:p>\n                <jats:p>This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-021-12245-y","type":"journal-article","created":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T12:02:31Z","timestamp":1638014551000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Delayed diagnosis of active pulmonary tuberculosis - potential risk factors for patient and healthcare delays in Portugal"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8564-1098","authenticated-orcid":false,"given":"Jo\u00e3o Almeida","family":"Santos","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0843-0630","authenticated-orcid":false,"given":"Andreia","family":"Leite","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5033-9115","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Soares","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2257-3099","authenticated-orcid":false,"given":"Raquel","family":"Duarte","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4562-1057","authenticated-orcid":false,"given":"Carla","family":"Nunes","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,11,27]]},"reference":[{"key":"12245_CR1","volume-title":"Global Tuberculosis Report 2020. 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Sarcoidosis Lancet. 2014;383(9923):1155\u201367.","journal-title":"Sarcoidosis Lancet"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-021-12245-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-021-12245-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-021-12245-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T18:05:31Z","timestamp":1675965931000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-021-12245-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,27]]},"references-count":55,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["12245"],"URL":"https:\/\/doi.org\/10.1186\/s12889-021-12245-y","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,27]]},"assertion":[{"value":"30 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study corresponds to a secondary data analysis of the Portuguese National Tuberculosis Surveillance System (SVIG-TB) dataset, which is supervised by the Directorate General of Health (Dire\u00e7\u00e3o Geral da Sa\u00fade, DGS). The DGS provides anonymized data for epidemiological research, which implies the removal of any personal data, therefore informed consent was not required. The study received approval from the research ethics committee of the Administra\u00e7\u00e3o Regional de Lisboa e Vale do Tejo (Reference 3514\/CES\/2019).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2178"}}