Delay between the onset of tuberculosis and its diagnosis or treatment is significantly longer in white people compared with black or Asian people, and in women compared with men, British researchers reported recently. "TB is rising at an alarming rate in London, and if it is not diagnosed quickly, patients can develop more severe illness or transmit the disease to other people," said Dr. Alison Rodger, the study's lead author. "There have recently been big campaigns of TB awareness amongst ethnic minority groups, but our data suggest that campaigns also need to be targeted at white people, who comprise a third of cases," she said.

In the study, Rodger, from the London School of Hygiene and Tropical Medicine, and colleagues analyzed data on TB cases collected by doctors in 1999-2000, and from a national survey conducted in 1998. They found that among 853 TB patients living in London, the delay between symptoms and diagnosis ranged from 14 to 103 days. The delay was longer than 49 days for half of the patients -- a finding consistent with those from other large cities in industrialized countries, the researchers noted. Their full report, "Delay in the Diagnosis of Pulmonary Tuberculosis, London, 1998-2000: Analysis of Surveillance Data," was published in the April 26 issue of the British Medical Journal (2003:326;909-910).

"We don't know whether the observed delays in diagnosis are due to patient delay in reporting symptoms or to a failure of GPs to recognize them," said Rodger.

The average delay in diagnosis among white patients was 72 days, compared with 43 days among all other ethnic groups. The delay was also significantly higher for women (72 days) than men (61 days). "This might be because TB may be suspected or investigated more readily among men or black or Asian people," the researchers wrote. In addition, physicians could be less likely to think about a TB diagnosis in women, Rodger said.

Co-author Dr. Shabbar Jaffar said the results could also mean some TB cases present differently between the sexes, or that men are more concerned about symptoms and come to the clinic at an earlier stage.

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