Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
BMJ Glob Health. 2021 Sep;6(9). doi: 10.1136/bmjgh-2020-003324.
In 2019, there are more than 290 million people who have ever migrated from rural to urban areas in China. These rural-to-urban internal migrants account for more than one-fifth of China's population and is the largest internal migrant group globally. We present the first systematic review that examines whether internal migrants are more likely to exhibit non-communicable diseases (NCDs) risk factors and have worse NCD management outcomes than non-migrant counterparts in China.
A systematic review was conducted via medical, public health, and economic databases including Scopus, MEDLINE, JSTOR, WHO Library Database and World Bank e-Library from 2000 to 2020. Study quality was assessed using the National Institute of Health Quality Assessment tool. We conducted a narrative review and synthesised differences for all studies included, stratified by different types of outcomes. We also conducted random-effects meta-analysis where we had a minimum of two studies with 95% CIs reported. The study protocol has been registered with PROSPERO: CRD42019139407.
For most NCD risk factors and care cascade management, comparisons between internal migrants and other populations were either statistically insignificant or inconclusive. While most studies found migrants have a higher prevalence of tobacco use than urban residents, these differences were not statistically significant in the meta-analysis. Although three out four studies suggested that migrants may have worse access to NCD treatment and both studies suggested migrants have lower blood pressure control rates than non-migrants, these findings were not statistically significant.
Findings from this systematic review demonstrate that there is currently insufficient evidence on migrant and non-migrant differences in NCD risk factors and management in China. Further research is expected to investigate access to healthcare among internal and its effect on both their NCD outcomes and long-term healthcare costs in China.
2019 年，中国有超过 2.9 亿人从农村迁移到城市。这些农村到城市的内部移民占中国人口的五分之一以上，是全球最大的内部移民群体。我们首次进行了系统评价，以检验在中国，内部移民是否比非移民更有可能表现出非传染性疾病（NCD）的危险因素，以及他们的 NCD 管理结果是否更差。
通过医学、公共卫生和经济数据库，包括 Scopus、MEDLINE、JSTOR、世界卫生组织图书馆数据库和世界银行电子图书馆，从 2000 年到 2020 年进行了系统评价。使用美国国立卫生研究院质量评估工具评估研究质量。我们进行了叙述性综述，并对所有纳入的研究进行了综合分析，按不同类型的结果进行了分层。我们还进行了随机效应荟萃分析，其中至少有两项研究报告了 95%置信区间。该研究方案已在 PROSPERO 上注册：CRD42019139407。
对于大多数 NCD 危险因素和护理级联管理，内部移民与其他人群之间的比较要么没有统计学意义，要么没有定论。虽然大多数研究发现移民的烟草使用率高于城市居民，但在荟萃分析中这些差异没有统计学意义。尽管四项研究中有三项表明移民获得 NCD 治疗的机会可能较差，而两项研究表明移民的血压控制率低于非移民，但这些发现没有统计学意义。
这项系统评价的结果表明，目前关于中国 NCD 危险因素和管理方面移民和非移民差异的证据不足。预计将进一步研究内部移民的医疗保健获取情况及其对他们的 NCD 结果和中国长期医疗保健成本的影响。
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