Tuberculosis in an Urban Area in China: Differences between Urban Migrants and Local Residents

Abstract

BackgroundThe increase in urban migrants is one of major challenges for tuberculosis control in China. The different characteristics of tuberculosis cases between urban migrants and local residents in China have not been investigated before.Methodology/Principal FindingsWe performed a retrospective study of all pulmonary tuberculosis patients reported in Songjiang district, Shanghai, to determine the demographic, clinical and microbiological characteristics of tuberculosis cases between urban migrants and local residents. We calculated the odds ratios (OR) and performed multivariate logistic regression to identify the characteristics that were independently associated with tuberculosis among urban migrants. A total of 1,348 pulmonary tuberculosis cases were reported during 2006–2008, among whom 440 (32.6%) were local residents and 908 (67.4%) were urban migrants. Urban migrant (38.9/100,000 population) had higher tuberculosis rates than local residents (27.8/100,000 population), and the rates among persons younger than age 35 years were 3 times higher among urban migrants than among local residents. Younger age (adjusted OR per additional year at risk = 0.92, 95% CI: 0.91–0.94, p<0.001), poor treatment outcome (adjusted OR = 4.12, 95% CI: 2.65–5.72, p<0.001), and lower frequency of any comorbidity at diagnosis (adjusted OR = 0.20, 95% CI: 0.13–0.26, p = 0.013) were significantly associated with tuberculosis patients among urban migrants. There were poor treatment outcomes among urban migrants, mainly from transfers to another jurisdiction (19.3% of all tuberculosis patients among urban migrants).Conclusions/SignificanceA considerable proportion of tuberculosis cases in Songjiang district, China, during 2006–2008 occurred among urban migrants. Our findings highlight the need to develop and implement specific tuberculosis control strategies for urban migrants, such as more exhaustive case finding, improved case management and follow-up, and use of directly observed therapy (DOT).

Factors associated with tuberculosis cases in Semarang District, Indonesia: case–control study performed in the area where case detection rate was extremely low

“…However, the MLR extracted high income as a risk as well. Such a result is not always in accordance with several studies [4,[23][24][25], whereas it is conceivable that people with high income, regardless of their occupation, have more chances to live and/or work at places with a lot of people where a risk of TB transmission is supposed to be high. The number was small, but only cases had a chance of close contact with TB patients.…”

“…Around 80 % of the cases were farmers and around 30 % had graduated from elementary school alone; hence, their income was lower than the controls. Low income and low education are reportedly associated with TB infection [4,[23][24][25]. They also had lost the chance of BCG injection.…”

Efforts to reduce the disparity between permanent residents and temporary migrants: Stop TB experiences in Shanghai, China

“…The health needs and implications of this sizeable population are considerable and constitute a vast challenge to its public health. A significant difference in access to TB services exists between registered residents and temporary migrants, and the healthcare system provides better care for TB cases among registered residents . To reduce the health disparity between registered residents and migrants and to further accelerate TB control programs, an initiative was launched in 8 of 19 districts in Shanghai since the end of 2006 (the number of districts was reduced to 17 in 2010 due to the merger of administrative units) to provide financial assistance to migrant TB cases.…”

Tuberculosis among migrants in Bishkek, the capital of the Kyrgyz Republic

“…Second, the treatment success rates of 74% for new TB and 44% for retreatment TB cases compare well with reports from other urban settings. 15,16 However, as migrants are a high-risk group for both acquiring and transmitting TB, we should be striving for much higher rates of treatment success-better, in fact, than those in the general population.…”