Lu Hui, Chen Jing, Wang Wei, Wu Laiwa, Shen Xin, Yuan Zhengan, Yan Fei
Department of Social Medicine, School of Public Health, Key Laboratory of Health Technology Assessment (Ministry of Health), Fudan University, Shanghai, China.
Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
Trop Med Int Health. 2015 Aug;20(8):1033-40. doi: 10.1111/tmi.12512. Epub 2015 Apr 14.
Eight of 17 districts of Shanghai have offered transportation and living allowances subsidies to patients with tuberculosis (TB) among the migrant population. The study aimed to assess the impact of the subsidising initiative on the treatment success rate (TSR) and identify the social determinants of treatment outcomes.
The participants included 7072 residents and 5703 migrants who were registered in the TB Information Management System with smear-positive pulmonary TB from January 2006 to December 2010. The Cochran-Armitage test was employed to test the trends of TSR and logistic regressions to identify the factors associated with treatment outcome.
Without subsidies, migrant TB cases had lower odds of successful treatment [OR = 0.20 (95% CI 0.18-0.23)] than resident cases. Subsidisation was associated with a 65% increased odds ratio of success [1.65 (1.40-1.95)] among migrant cases. The TSR has stabilised at 87% for both permanent residents and temporary migrants since 2009. Living in districts with a population density ≥20,000/km(2) was associated with a low odds ratio [0.42 (0.26-0.68)] among resident cases, whereas among migrant cases those living in districts out of central downtown had a higher odds ratio of treatment success [peripheral downtown: 1.73 (1.36-2.20), suburban: 1.69 (1.16-2.46)]. The TB cases in districts with 2.0-2.9 TB specialists/100 cases had a higher odds ratio [2.99 (1.91-4.69)] of successful treatment than cases from districts with fewer specialists.
Besides free medical services, transport and living allowance subsidies to migrant patients with TB improved the treatment outcome significantly.
上海17个区中有8个区已为流动人口中的结核病患者提供交通和生活津贴补贴。本研究旨在评估补贴举措对治疗成功率（TSR）的影响，并确定治疗结果的社会决定因素。
研究对象包括2006年1月至2010年12月在结核病信息管理系统中登记的7072名本地居民和5703名流动人口涂片阳性肺结核患者。采用 Cochr an - Armitage检验来检验治疗成功率的趋势，并采用逻辑回归分析来确定与治疗结果相关的因素。
在没有补贴的情况下，流动人口结核病病例成功治疗的几率[比值比（OR）=0.20（95%置信区间0.18 - 0.23）]低于本地居民病例。补贴使流动人口病例成功治疗的几率比提高了65%[1.65（1.40 - 1.95）]。自2009年以来，本地居民和临时流动人口的治疗成功率均稳定在87%。居住在人口密度≥20000人/平方公里的地区的本地居民病例治疗成功几率比低[0.42（0.26 - 0.68）]，而在流动人口病例中，居住在市中心以外地区的治疗成功几率比更高[市中心周边地区：1.73（1.36 - 2.20），郊区：1.69（1.16 - 2.46）]。每100例病例中有2.0 - 2.9名结核病专科医生的地区的结核病病例成功治疗的几率比[2.99（1.91 - 4.69）]高于专科医生较少地区的病例。
除免费医疗服务外，为流动人口结核病患者提供交通和生活津贴补贴显著改善了治疗效果。
