Temporal trends and determinants of delayed care-seeking after rabies exposure: a 27,930-patient analysis in Tianjin.

OBJECTIVE: Prompt care-seeking after rabies exposure is essential for effective post-exposure prophylaxis (PEP). This study aimed to identify independent factors associated with care-seeking delay and to map the full PEP pathway. METHODS: We retrospectively enrolled 27,930 patients attending the rabies PEP clinic at Santan Hospital, Tianjin, between February 2022 and January 2026. Delay was defined as >12 h from exposure to registration. Multivariable logistic regression, combined with XGBoost and SHAP, identified independent factors for delay and quantified their relative importance. Restricted cubic splines examined the non-linear relationship between age and delay. Subgroup analysis assessed the stability of the association of grade III exposure with more prompt care-seeking. A Sankey diagram traced the PEP pathway. RESULTS: The delay rate was 29.7%. Eight independent factors were identified. Adults had a 34% higher risk of delay than children (aOR = 1.34, 95% CI: 1.22-1.47, P < 0.001). Grade III exposure was associated with more prompt care-seeking (aOR = 0.69, 95% CI: 0.65-0.73, P < 0.001). Previous rabies vaccination (aOR = 1.17, 95% CI: 1.11-1.23, P < 0.001) and inadequate wound management (aOR = 1.57, 95% CI: 1.31-1.88, P < 0.001) were associated with higher delay risk. Age showed a non-linear relationship with delay risk, with adults at highest risk. The Sankey diagram showed that inadequate wound management was rare in the PEP pathway, and the two-dose booster schedule achieved a much higher completion rate than the standard schedule. CONCLUSIONS: Our findings suggest that adults may face the highest risk of care-seeking delay, and that improving healthcare access for adults and promoting simplified vaccination schedules may be key to improving PEP quality.