Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
Euro Surveill. 2013 Mar 21;18(12):20433.
Non-national migrants have limited access to medical therapy. This study compares diagnostic delay and treatment outcomes of non-insured non-national migrants (NINNM) with insured Israeli citizens (IC) in the Tel Aviv tuberculosis (TB) clinic between 1998 and 2008. Patient delay was the time from symptoms onset to doctor's visit, while system delay was measured from doctor visit to anti-TB therapy administration. We randomly sampled 222 NINNM and 265 IC. NINNM were younger than IC, had lower male to female ratio and fewer smoked. They had less drug/alcohol abuse, more cavitations on chest radiography, longer patient and shorter system delay. Mean patient and system delays of all patients were 25 ± 14 and 79 ± 42 days, respectively. In multivariate analysis, being NINNM, asymptomatic or smoking predicted longer patient delay, while being asymptomatic or having additional co-morbidity predicted longer system delay. Treatment success in sputum smear-positive pulmonary TB NINNM was 81% and 95.7% in IC (p=0.01). Treatment success was not associated with patient or system delay. In multivariate analysis, work security and treatment adherence predicted treatment success. NINNM had longer patient delay and worse therapy outcome, while IC had longer system delay. Both delays should be reduced. NINNM should be informed that TB therapy is free and unlinked with deportation.
非本国移民获得医疗治疗的机会有限。本研究比较了 1998 年至 2008 年间在特拉维夫结核病（TB）诊所中未参保的非本国移民（NINNM）与参保的以色列公民（IC）的诊断延迟和治疗结果。患者延迟是指从症状出现到就诊的时间，而系统延迟是指从就诊到开始抗结核治疗的时间。我们随机抽取了 222 名 NINNM 和 265 名 IC。NINNM 比 IC 更年轻，男女比例更低，吸烟人数更少。他们滥用药物/酒精的情况较少，胸部 X 光片上有空洞，患者延迟时间较短，系统延迟时间较长。所有患者的平均患者延迟和系统延迟分别为 25 ± 14 和 79 ± 42 天。多变量分析显示，NINNM、无症状或吸烟会导致患者延迟时间延长，而无症状或合并其他合并症会导致系统延迟时间延长。痰涂片阳性肺结核 NINNM 的治疗成功率为 81%，IC 为 95.7%（p=0.01）。治疗成功率与患者或系统延迟无关。多变量分析显示，工作保障和治疗依从性预测治疗成功率。NINNM 的患者延迟时间较长，治疗结果较差，而 IC 的系统延迟时间较长。这两个延迟都应该减少。应该告知 NINNM，结核病治疗是免费的，与驱逐出境无关。
