Exposures associated with tuberculosis presentation and healthcare delays in South West England, 2015–2020

Gemma Lyness; Neville Q. Verlander; Charles R. Beck

doi:10.1371/journal.pone.0340187

Exposures associated with tuberculosis presentation and healthcare delays in South West England, 2015–2020

Gemma Lyness^*
, Neville Q. Verlander
, Charles R. Beck

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Significant progress has been made in reducing the tuberculosis (TB) rate in England over the last decade. South West England has a low incidence of TB, but over a third of people with pulmonary TB (pTB) had a treatment delay of over four months in 2020, higher than the England average. This study aimed to identify the exposures associated with presentation and healthcare delays in receiving pTB treatment in the South West of England between 2015 and 2020. This retrospective cohort study included all confirmed persons with TB resident in South West England, receiving treatment between 2015 and 2020. Univariate and multivariable Cox proportional hazards ratios were produced for the outcome measures of presentation and healthcare delays for persons with pTB. Multivariable regression models were fitted using a forward, stepwise procedure. Sensitivity analyses excluded treatment delays over two years and the year 2020. Data were analysed using Stata 17. Between 2015 and 2020 there were 812 persons with pTB among South West residents. Median treatment delays were 35 days for presentation and 25 days for healthcare delay. Multivariable analysis identified that longer presentation delays were associated with being aged 35–50 or over 80 years old. Longer healthcare delays were associated with increasing age (hazard ratio [HR]: 0.99, 95% CI: 0.98–0.99), being employed (HR: 0.71, 95% CI: 0.52–0.97) and people currently or historically deprived of their liberty and accommodated by a prison (HR: 0.33, 95% CI: 0.20–0.54). Shorter healthcare delays were associated with sputum smear positivity (HR: 1.54, 95% CI: 1.16–2.06) and smoking (HR: 1.64, 95% CI: 1.22–2.22). Delays between symptom onset and TB treatment remain an important public health problem in the region. Factors have been identified that can be investigated to reduce presentation and healthcare delays. Detailed analyses were valuable in disaggregating key populations. Further mixed-methods research would be warranted to further understand these associations.

Original language	English
Article number	e0340187
Pages (from-to)	e0340187
Journal	PLoS ONE
Volume	21
Issue number	1 January
DOIs	https://doi.org/10.1371/journal.pone.0340187
Publication status	Published - 7 Jan 2026

Bibliographical note

Publisher Copyright:
© 2026 Lyness et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Access to Document

10.1371/journal.pone.0340187

Cite this

@article{178e369e235340f78f63bf4983745429,

title = "Exposures associated with tuberculosis presentation and healthcare delays in South West England, 2015–2020",

abstract = "Significant progress has been made in reducing the tuberculosis (TB) rate in England over the last decade. South West England has a low incidence of TB, but over a third of people with pulmonary TB (pTB) had a treatment delay of over four months in 2020, higher than the England average. This study aimed to identify the exposures associated with presentation and healthcare delays in receiving pTB treatment in the South West of England between 2015 and 2020. This retrospective cohort study included all confirmed persons with TB resident in South West England, receiving treatment between 2015 and 2020. Univariate and multivariable Cox proportional hazards ratios were produced for the outcome measures of presentation and healthcare delays for persons with pTB. Multivariable regression models were fitted using a forward, stepwise procedure. Sensitivity analyses excluded treatment delays over two years and the year 2020. Data were analysed using Stata 17. Between 2015 and 2020 there were 812 persons with pTB among South West residents. Median treatment delays were 35 days for presentation and 25 days for healthcare delay. Multivariable analysis identified that longer presentation delays were associated with being aged 35–50 or over 80 years old. Longer healthcare delays were associated with increasing age (hazard ratio [HR]: 0.99, 95\% CI: 0.98–0.99), being employed (HR: 0.71, 95\% CI: 0.52–0.97) and people currently or historically deprived of their liberty and accommodated by a prison (HR: 0.33, 95\% CI: 0.20–0.54). Shorter healthcare delays were associated with sputum smear positivity (HR: 1.54, 95\% CI: 1.16–2.06) and smoking (HR: 1.64, 95\% CI: 1.22–2.22). Delays between symptom onset and TB treatment remain an important public health problem in the region. Factors have been identified that can be investigated to reduce presentation and healthcare delays. Detailed analyses were valuable in disaggregating key populations. Further mixed-methods research would be warranted to further understand these associations.",

author = "Gemma Lyness and Verlander, \{Neville Q.\} and Beck, \{Charles R.\}",

note = "Publisher Copyright: {\textcopyright} 2026 Lyness et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2026",

month = jan,

day = "7",

doi = "10.1371/journal.pone.0340187",

language = "English",

volume = "21",

pages = "e0340187",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "1 January",

}

TY - JOUR

T1 - Exposures associated with tuberculosis presentation and healthcare delays in South West England, 2015–2020

AU - Lyness, Gemma

AU - Verlander, Neville Q.

AU - Beck, Charles R.

N1 - Publisher Copyright: © 2026 Lyness et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2026/1/7

Y1 - 2026/1/7

N2 - Significant progress has been made in reducing the tuberculosis (TB) rate in England over the last decade. South West England has a low incidence of TB, but over a third of people with pulmonary TB (pTB) had a treatment delay of over four months in 2020, higher than the England average. This study aimed to identify the exposures associated with presentation and healthcare delays in receiving pTB treatment in the South West of England between 2015 and 2020. This retrospective cohort study included all confirmed persons with TB resident in South West England, receiving treatment between 2015 and 2020. Univariate and multivariable Cox proportional hazards ratios were produced for the outcome measures of presentation and healthcare delays for persons with pTB. Multivariable regression models were fitted using a forward, stepwise procedure. Sensitivity analyses excluded treatment delays over two years and the year 2020. Data were analysed using Stata 17. Between 2015 and 2020 there were 812 persons with pTB among South West residents. Median treatment delays were 35 days for presentation and 25 days for healthcare delay. Multivariable analysis identified that longer presentation delays were associated with being aged 35–50 or over 80 years old. Longer healthcare delays were associated with increasing age (hazard ratio [HR]: 0.99, 95% CI: 0.98–0.99), being employed (HR: 0.71, 95% CI: 0.52–0.97) and people currently or historically deprived of their liberty and accommodated by a prison (HR: 0.33, 95% CI: 0.20–0.54). Shorter healthcare delays were associated with sputum smear positivity (HR: 1.54, 95% CI: 1.16–2.06) and smoking (HR: 1.64, 95% CI: 1.22–2.22). Delays between symptom onset and TB treatment remain an important public health problem in the region. Factors have been identified that can be investigated to reduce presentation and healthcare delays. Detailed analyses were valuable in disaggregating key populations. Further mixed-methods research would be warranted to further understand these associations.

AB - Significant progress has been made in reducing the tuberculosis (TB) rate in England over the last decade. South West England has a low incidence of TB, but over a third of people with pulmonary TB (pTB) had a treatment delay of over four months in 2020, higher than the England average. This study aimed to identify the exposures associated with presentation and healthcare delays in receiving pTB treatment in the South West of England between 2015 and 2020. This retrospective cohort study included all confirmed persons with TB resident in South West England, receiving treatment between 2015 and 2020. Univariate and multivariable Cox proportional hazards ratios were produced for the outcome measures of presentation and healthcare delays for persons with pTB. Multivariable regression models were fitted using a forward, stepwise procedure. Sensitivity analyses excluded treatment delays over two years and the year 2020. Data were analysed using Stata 17. Between 2015 and 2020 there were 812 persons with pTB among South West residents. Median treatment delays were 35 days for presentation and 25 days for healthcare delay. Multivariable analysis identified that longer presentation delays were associated with being aged 35–50 or over 80 years old. Longer healthcare delays were associated with increasing age (hazard ratio [HR]: 0.99, 95% CI: 0.98–0.99), being employed (HR: 0.71, 95% CI: 0.52–0.97) and people currently or historically deprived of their liberty and accommodated by a prison (HR: 0.33, 95% CI: 0.20–0.54). Shorter healthcare delays were associated with sputum smear positivity (HR: 1.54, 95% CI: 1.16–2.06) and smoking (HR: 1.64, 95% CI: 1.22–2.22). Delays between symptom onset and TB treatment remain an important public health problem in the region. Factors have been identified that can be investigated to reduce presentation and healthcare delays. Detailed analyses were valuable in disaggregating key populations. Further mixed-methods research would be warranted to further understand these associations.

UR - https://www.scopus.com/pages/publications/105026964146

UR - https://www.mendeley.com/catalogue/196880c6-2686-343f-a144-6d57f358cd9e/

U2 - 10.1371/journal.pone.0340187

DO - 10.1371/journal.pone.0340187

M3 - Article

C2 - 41499473

AN - SCOPUS:105026964146

SN - 1932-6203

VL - 21

SP - e0340187

JO - PLoS ONE

JF - PLoS ONE

IS - 1 January

M1 - e0340187

ER -

Exposures associated with tuberculosis presentation and healthcare delays in South West England, 2015–2020

Abstract

Bibliographical note

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this