Lin Kunhe, Xiang Li
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
HUST Base of National Institute of Healthcare Security, Wuhan, People's Republic of China.
Risk Manag Healthc Policy. 2024 Mar 26;17:727-737. doi: 10.2147/RMHP.S448706. eCollection 2024.
Multidrug resistant tuberculosis (MDR-TB) has attracted increasing attention in achieving the global goal of tuberculosis (TB) control. China has the second largest TB burden worldwide and has been experiencing large-scale domestic migration. This study aims to explore the effect of migrants on non-adherence to MDR-TB treatment.
A cross-sectional study was carried out in Wuhan, China. The exposure cases were migrants who were not locally registered in the residence registration system. The control cases were local residents. Non-adherence cases were patients who were lost follow-up or refused treatment. Chi-square and -test were used to compare variables between migrants and local residents. Logistic regression models using enter method were used to determine the relationship between migration and non-adherence to treatment. Moderation and medication effects on the association between migrant status and non-adherence were also explored.
We studied 73 migrants and 219 local residents. The migrants, who did not to adhere to treatment (55, 75.3%), was far higher than that of local residents (89, 40.6%). Migrants with MDR-TB had 10.38-times higher difficulty in adhering to treatment (adjusted OR = 10.38, 95% CI 4.62-25.28) than local residents. This additional likelihood was moderated by age and treatment registration group. Migration had an indirect association with non-adherence to treatment via social medial insurance (adjusted OR = 1.05, 95% CI 1.01-1.13).
There a significant increased likelihood of non-adherence to treatment among migrants with MDR-TB, highlighting the importance of improving treatment adherence in this population. Migration prevented migrants from gaining access to social medical insurance and indirectly reduced their likelihood of adherence to treatment.
耐多药结核病（MDR-TB）在实现全球结核病（TB）控制目标方面日益受到关注。中国是全球结核病负担第二大的国家，且一直存在大规模的国内人口迁移。本研究旨在探讨流动人口对耐多药结核病治疗依从性的影响。
在中国武汉进行了一项横断面研究。暴露组为户籍不在当地的流动人口。对照组为当地居民。不依从病例为失访或拒绝治疗的患者。采用卡方检验和t检验比较流动人口和当地居民之间的变量。使用逐步回归法的逻辑回归模型来确定迁移与治疗不依从之间的关系。还探讨了调节因素和药物因素对流动人口身份与治疗不依从之间关联的影响。
我们研究了73名流动人口和219名当地居民。流动人口中不坚持治疗的比例（55例，75.3%）远高于当地居民（89例，40.6%）。耐多药结核病流动人口坚持治疗的难度比当地居民高10.38倍（调整后的OR = 10.38，95% CI 4.62 - 25.28）。年龄和治疗登记组对这种额外的可能性有调节作用。迁移通过社会医疗保险与治疗不依从存在间接关联（调整后的OR = 1.05，95% CI 1.01 - 1.13）。
耐多药结核病流动人口治疗不依从的可能性显著增加，凸显了提高该人群治疗依从性的重要性。迁移使流动人口难以获得社会医疗保险，并间接降低了他们坚持治疗的可能性。
