Defining migration and its health impact in China

The Role of Social Integration in Chronic Disease Prevalences Among the Internal Migrant Populations in China: Evidence from a National Survey

Background: China has the world's largest internal migrant population, yet chronic disease prevalence among this group remains largely overlooked. The integration of the internal migrant population into the local society may affect their noncommunicable disease prevalences and become a challenge for the public health system. This study aimed to explore the association between the social integration of China's internal migrant population and the prevalences of chronic diseases, including hypertension and diabetes. Methods: This study used data from the 2017 China Migration Dynamic Survey. Social integration status was assessed using an 8-item Likert scale and categorized into four quartiles, with higher points indicating higher levels of social integration. Multivariate logistic regression was conducted to examine the association between social integration level and the prevalences of hypertension, diabetes and combined chronic diseases. Disaggregated analysis was performed to explore the potential effect modification by age, sex, income, and migration duration. Results: A medium level of social integration was associated with lower prevalences of chronic diseases, while the lowest and highest levels of social integration were both associated with enhanced prevalence. Further disaggregation demonstrated the relationship between social integration and chronic disease prevalences were modified by various factors, including age, sex, income, and migration duration. Conclusions: This study demonstrated that both the lowest and highest levels of social integration can significantly affect chronic disease outcomes of China's internal migrants. These findings emphasize the necessity to formulate tailored public health policies to effectively prevent and manage chronic diseases among the internal migrant population in China.

Effect of an Endoscopy Screening on Upper Gastrointestinal Cancer Mortality: A Community-Based Multicenter Cluster Randomized Clinical Trial

BACKGROUND AND AIMS

Population-based observational studies suggest that endoscopic screening may reduce upper gastrointestinal cancer mortality. We aimed to quantify the effect of endoscopy screening.

METHODS

This is a community-based, multicenter, cluster randomized clinical trial conducted in both high-risk and non-high-risk areas of China. Randomization and recruitment occurred between 2015 and 2017, with follow-up conducted until 2022. The intervention was an invitation to receive endoscopic screening, as opposed to receiving usual care (unscreened). In non-high-risk areas, only participants assessed as high-risk by risk scores in the screening group were invited for endoscopic screening. The primary outcome was the cumulative risk of death from upper gastrointestinal cancer, adjusted for baseline characteristics and cluster effects.

RESULTS

A total of 234,635 participants were included in the intention-to-screen analysis, with a median age of 52 years. In high-risk areas, 64,836 individuals from 81 clusters were randomized to the screening group, and 59,379 individuals from 82 clusters were randomized to the control group. In non-high-risk areas, 58,367 individuals from 92 clusters were randomized to the screening group, 52,053 individuals from 90 clusters were randomized to the control group. Among high-risk areas, 480 (adjusted cumulative risk, 0.77%) died due to upper gastrointestinal cancers within 7.5 years in the screening group vs 545 (0.99%) deaths in the control group (risk ratio, 0.78; 95% confidence interval, 0.66-0.91). Among non-high-risk areas, adjusted risk was 0.26% (146 deaths) in the screening group and 0.30% (149 deaths) in the control group (risk ratio, 0.86; 95% confidence interval, 0.65-1.13).

CONCLUSIONS

An invitation to endoscopic screening reduced upper gastrointestinal cancer mortality in high-risk areas. In non-high-risk areas, an invitation to endoscopic screening based on risk scores did not significantly decrease upper gastrointestinal cancer deaths, but longer follow-up time was required. (Chinese Clinical Trial Registry Identifier: ChiCTR-EOR-16008577.).

Genomic analysis of lineage-specific transmission of multidrug resistance tuberculosis in China

OBJECTIVES

We investigated the genetic diversities and lineage-specific transmission dynamics of multidrug-resistant tuberculosis (MDR-TB), with the goal of determining the potential factors driving the MDR epidemics in China.

METHODS

We curated a large nationwide Mycobacterium tuberculosis (M. tuberculosis) whole genome sequence data set, including 1313 MDR strains. We reconstructed the phylogeny and mapped the transmission networks of MDR-TB across China using Bayesian inference. To identify drug-resistance variants linked to enhanced transmissibility, we employed ordinary least-squares (OLS) regression analysis.

RESULT

The majority of MDR-TB strains in China belong to lineage 2.2.1. Transmission chain analysis has indicated that the repeated and frequent transmission of L2.2.1 plays a central role in the establishment of MDR epidemic in China, but no occurrence of a large predominant MDR outbreak was detected. Using OLS regression, the most common single nucleotide polymorphisms (SNPs) associated with resistance to isoniazid (katG_p.Ser315Thr and katG_p.Ser315Asn) and rifampicin (rpoB_p.Ser450Leu, rpoB_p.His445Tyr, rpoB_p.His445Arg, rpoB_p.His445Asp, and rpoB_p.His445Asn) were more likely to be found in L2 clustered strains. Several putative compensatory mutations in rpoA, rpoC, and katG were significantly associated with clustering. The eastern, central, and southern regions of China had a high level of connectivity for the migration of L2 MDR strains throughout the country. The skyline plot showed distinct population size expansion dynamics for MDR-TB lineages in China.

CONCLUSION

MDR-TB epidemic in China is predominantly driven by the spread of highly transmissible Beijing strains. A range of drug-resistance mutations of L2 MDR-TB strains displayed minimal fitness costs and may facilitate their transmission.

Impact of family doctor contracted services on the health of migrants: a cross-sectional study in China

This study investigates the impact of the family doctor contracted service system on the health of migrants in China, utilizing data from the 2018 China Migrants Dynamic Survey (CMDS). The study employs a double machine learning model to estimate the effect of family doctor contracted services (FDCS) on migrants' self-rated health (MSRH). The sample consists of 137,851 migrants, with family doctor service contract status, health education, and health records as key variables. To address potential endogeneity issues, an instrumental variable approach using the regional family doctor contracting rate was implemented. Mediation analysis was conducted to examine the roles of health education and health records in this relationship. The findings indicate that FDCS significantly improve MSRH. This positive effect is robust across various machine learning models, including Lassocv, Random Forest, and Gradient Boost. The instrumental variable approach confirms the validity of these results, mitigating concerns about endogeneity. Mediation analysis reveals that the positive impact of FDCS on MSRH is fully mediated by health education and health records, highlighting their critical roles in enhancing health outcomes. The FDCS play a crucial role in improving the health of migrants by providing continuous and comprehensive care. Enhanced health education and effective health records management are significant pathways through which these services exert their positive effects. Policy recommendations include expanding access to family doctor services, enhancing health education programs, and improving health records management to optimize healthcare delivery for migrants. Future research should consider longitudinal studies to further validate these findings and explore their applicability to specific subgroups or regions.

The prevalence of preterm and low birth weight infants among migrant women in the Pearl River Delta region, China: a population-based birth cohort study

BACKGROUND

The existing literature evaluating the association between neonatal morbidity and migrant status presents contradictory results. The purpose of this study was to compare the risk of preterm birth (PTB) and low birth weight (LBW) among newborns from local and migrant women in China's Pearl River Delta (PRD) region.

METHODS

In this observational population-based study, we included all live singleton deliveries from PRD region local women and migrant women. Data were sourced from the Guangdong Medical Birth Registry Information System between Jan 1, 2014, and Dec 31, 2020. Women were categorized into three groups by maternal migrant status: local women from PRD region, migrant women from Guangdong province or from other provinces. The outcome variables that were examined included two adverse birth outcomes: PTB and LBW. The association between the risk of PTB and LBW and maternal migrant status was assessed using logistic regression.

RESULTS

During 2014-2020, 5,219,133 single live deliveries were recorded, corresponding 13.22% to local women and the rest to migrant women coming from Guangdong (53.51%) and other provinces (33.26%). PTB prevalence was highest among local women (5.79%), followed by migrant women from Guangdong (5.29%), and the lowest among migrants from other provinces (4.95%). This association did not change after including maternal age, infant sex, delivery mode, and birth season in the models. Compared to local women, migrant women from other provinces had a lower risk of LBW (4.00% vs. 4.98%, P < 0.001). The prevalence of PTB and LBW was higher among local women than migrants. The odds of delivery PTB and LBW were higher for women who were age ≥ 35. Among the three maternal migration groups, the age-LBW association displayed a typical U-shaped pattern, with those in the youngest (16-24 years) and oldest (≥ 35) age categories exhibiting the higher odds of delivering a LBW neonate. With respect to infant sex, the prevalence of PTB was significantly higher in males than females among the three maternal migration groups. An opposite trend was found for LBW, and the prevalence of LBW was higher in females among the three maternal migration groups.

CONCLUSION

The findings of this study contribute to the understanding of the epidemiology of PTB and LBW among migrant women. Our study suggests that it is the health and robust nature of migrant mothers that predisposes them to better birth outcomes. It is important to recognize that the results of this study, while supportive of the healthy migrant effect, cannot be considered definitive without some exploration of motivation for moving and changes in lifestyle postmigration.

How is intergenerational emotional cohesion linked to depression among older internal migrants in China: the mediating roles of loneliness and perceived stress

BACKGROUND

Late-life internal migration is frequently associated with a higher risk of depression in older parents. This research delves into the impact of intergenerational emotional cohesion (IEC) on depression in older internal migrants and the underlying mechanisms within the contemporary Chinese context.

METHODS

Obtained from a cross-sectional survey in Nanjing, China, the research involved 654 older internal migrants (66.97% female; mean age = 66.05 years; SD = 4.67). Variables were assessed using the Intergenerational Solidarity Inventory, 3-item R-UCLA Loneliness Scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire (PHQ-9). For mediation exploration, a serial mediation model was utilized, and the Bootstrap method was employed to test the signifcance of these mediation effects.

RESULTS

IEC demonstrates a negative correlation with depression. Through IEC, three significant mediation pathways were identified that directly affect depression: (1) loneliness (β=-0.06; Ratio=17.14%), (2) perceived stress (β=-0.09; Ratio=25.71%), and (3) loneliness and perceived stress (β=-0.03; Ratio=8.57%).

CONCLUSIONS

IEC can impact the depression of older internal migrants by mitigating negative psychological emotions during the migration process. This finding provides valuable theoretical insights for the prevention of mental health problems among this demographic.

The quality of migrant patients' primary healthcare experiences and patient-centered medical home achievement by community health centers: results from the China greater bay area study

BACKGROUND

In China, Community Health Centers (CHCs) provide primary healthcare (PHC); however, few studies have examined the quality of PHC services experienced by migrant patients. We examined the potential association between the quality of migrant patients' PHC experiences and the achievement of Patient-Centered Medical Home by CHCs in China.

METHODS

Between August 2019 and September 2021, 482 migrant patients were recruited from ten CHCs in China's Greater Bay Area. We evaluated CHC service quality using the National Committee for Quality Assurance Patient-Centered Medical Home (NCQA-PCMH) questionnaire. We additionally assessed the quality of migrant patients' PHC experiences using the Primary Care Assessment Tools (PCAT). General linear models (GLM) were used to examine the association between the quality of migrant patients' PHC experiences and the achievement of PCMH by CHCs, adjusting for covariates.

RESULTS

The recruited CHCs performed poorly on PCMH1, Patient-Centered Access (7.2 ± 2.0), and PCMH2, Team-Based Care (7.4 ± 2.5). Similarly, migrant patients assigned low scores to PCAT dimension C-First-contact care-which assesses access (2.98 ± 0.03), and D-Ongoing care (2.89 ± 0.03). On the other hand, higher-quality CHCs were significantly associated with higher total and dimensional PCAT scores, except for dimensions B and J. For example, the total PCAT score increased by 0.11 (95% CI: 0.07-0.16) with each increase of CHC PCMH level. We additionally identified associations between older migrant patients (> 60 years) and total PCAT and dimension scores, except for dimension E. For instance, the average PCAT score for dimension C among older migrant patients increased by 0.42 (95% CI: 0.27-0.57) with each increase of CHC PCMH level. Among younger migrant patients, this dimension only increased by 0.09 (95% CI: 0.03-0.16).

CONCLUSION

Migrant patients treated at higher-quality CHCs reported better PHC experiences. All observed associations were stronger for older migrants. Our results may inform future healthcare quality improvement studies that focus on the PHC service needs of migrant patients.

The Residential Environment and Health and Well-Being of Chinese Migrant Populations: A Systematic Review

China's internal migrants suffer from marginalised housing conditions, poor neighbourhood environments and residential segregation, which may have significant implications on health and well-being. Echoing recent calls for interdisciplinary research on migrant health and well-being, this study examines the associations and mechanisms of the impact of the residential environment on the health and well-being of Chinese migrants. We found that most of the relevant studies supported the "healthy migration effect", but the phenomenon was only applicable to migrants' self-reported physical health rather than mental health. The subjective well-being of migrants is lower than that of urban migrants. There is a debate between the effectiveness of residential environmental improvements and the ineffectiveness of residential environmental improvements in terms of the impact of the neighbourhood environment on migrants' health and well-being. Housing conditions and the neighbourhood's physical and social environment can enhance migrants' health and well-being by strengthening place attachment and social cohesion, building localised social capital and gaining neighbourhood social support. Residential segregation on the neighbourhood scale affects the health outcomes of migrant populations through the mechanism of relative deprivation. Our studies build a vivid and comprehensive picture of research to understand migration, urban life and health and well-being.

Unmet healthcare needs predict frailty onset in the middle-aged and older population in China: A prospective cohort analysis

Objectives

Older populations have a relatively high prevalence of unmet healthcare needs, which can result in poor health status. Moreover, in the coming century, frailty is expected to become one of the most serious global public health challenges. However, there is a lack of clear evidence proving an association between unmet healthcare needs and frailty. This study aimed to assess whether unmet healthcare needs predict the onset of frailty in China.

Methods

The association between frailty and unmet healthcare needs was explored by analyzing data from the China Health and Retirement Longitudinal Study (CHARLS) using random-effects logistic regression and Cox regression with time-varying exposure.

Results

At baseline, 7,719 respondents were included in the analysis. Random-effects logistic regression shows that unmet outpatient healthcare needs were associated with increased risk of both contemporaneous (adjusted OR [aOR], 1.17; 95% CI, 1.02-1.35) and lagged (aOR, 1.24; 95% CI, 1.05-1.45) frailty, as were unmet inpatient needs (contemporaneous: aOR, 1.28; 95% CI, 1.00-1.64; lagged: aOR, 1.55; 95% CI, 1.17-2.06). For respondents not classified as frail at baseline (n = 5,392), Cox regression with time-varying exposure shows significant associations of both unmet outpatient needs (adjusted HR, 1.23; 95% CI, 1.05-1.44) and unmet inpatient needs (adjusted HR, 1.48; 95% CI, 1.11-1.99) with increased risk of developing frailty.

Conclusions

Reducing unmet healthcare needs would be a valuable intervention to decrease frailty risk and promote healthy aging in middle-aged and older populations. It is urgent and essential that the equity and accessibility of the medical insurance and health delivery systems be strengthened.

Characteristics of road traffic accident types and casualties in Guangzhou, China, from 2007 to 2020: A retrospective cohort study based on the general population

Introduction

This study aimed to explore the trend and main influencing factors of road traffic accidents in Guangzhou, China, from 2007 to 2020 and to provide a reference and guidance for government decision-making.

Methods

A retrospective cohort study was used to describe road traffic accidents in Guangzhou. According to the population types, all people with road traffic accidents were divided into migrant workers and the control population. We divided road users, administrative districts, motorcycle types and injury levels into subgroups to investigate the characteristics of road traffic accidents in Guangzhou. The road traffic accident data were derived from the Guangzhou Public Security Traffic Management Integrated System.

Results

The incidence rate of road traffic accidents per 10,000 vehicles in Guangzhou decreased from 36.55 in 2007 to 10.07 in 2012, remained relatively stable at 9.47 in 2017, and finally rose to 11.12 in 2020. The injury rate showed the same trend as the incidence rate, while the mortality rate gradually decreased from 14.21 in 2007 to 5.19 in 2020. Vulnerable road users such as motorized two-to-three-wheeler drivers and migrant workers were casualties in more than 80% of the cases. The proportion of casualties involving mopeds and electric bicycles increased rapidly after 2018. Motor vehicle drivers frequently caused road traffic accidents and were most often uninjured.

Conclusion

Road safety in Guangzhou has shown a clear trend of improvement, but casualties are uneven across administrative districts. More attention should be given to motorized two-to-three-wheelers, migrant workers, and road traffic violations by uninjured individuals.

Urban-rural disparities in the healthy ageing trajectory in China: a population-based study

Purpose

The aim of this study is to measure the trajectory of healthy ageing among Chinese middle-aged and older population, and explore the disparity of the trajectory, as well as contributing factors, between urban and rural areas in China.

Methods

A total of 9402 respondents aged 45 years and older interviewed in four waves (2011, 2013, 2015 and 2018) were selected from the China Health and Retirement Longitudinal Study. Healthy ageing score was calculated through item response theory. A latent growth mixture model (LGMM) was applied to distinguish the trajectory of healthy aging. A multinomial logistics regression model (MLRM) was used to explore the relationship between urban-rural areas and healthy aging trajectories, and further to explore associated factors in rural and urban areas separately.

Results

The healthy ageing score was lower in rural areas than urban areas in each survey wave. Five classes (“continuing-low”, “continuing-middle”, “continuing-middle-to-high”, “significantly-declining”, “continuing-high”) were grouped through LGMM. The MLRM results showed that urban living was significantly associated with a higher likelihood of being healthy (for [continuing-low/continuing-high]: β = − 1.17, RRR = 0.31, P < 0.001, 95% CI = 0.18–0.53; and for [continuing-middle/continuing-high]: β = − 0.53, RRR = 0.59, P < 0.001, 95% CI = 0.49–0.71).

Conclusion

Healthy ageing is a prominent objective in the development of a country, and rural-urban disparities are an essential obstacle to overcome, with the rural population more likely to develop a low level of healthy ageing trajectory. Prevention and standardized management of chronic diseases should be enhanced, and social participation should be encouraged to promote healthy ageing. The policy inclination and resource investment should be enhanced to reduce disparity in healthy ageing between urban and rural areas in China.

Association of COVID-19 Lockdown during the Perinatal Period with Postpartum Depression: Evidence from Rural Areas of Western China

COVID-19 lockdown has posed unique challenges to postpartum women, but its association with postpartum depression is not well understood in the Global South. This study aims to evaluate the association between COVID-19 lockdown and postpartum depression in rural areas of western China. A multi-stage random cluster sampling method was used to select a cohort of pregnant and postpartum women with infants aged 0-6 months. We conducted an in-person survey before the COVID-19 lockdown and a phone survey right after the lockdown ended. We used multivariate regression models to evaluate the association between lockdown and postpartum depression. Subgroup analysis was performed to explore the role of social support. The overall prevalence of postpartum depression was 13.3%. Postpartum women who experienced the lockdown were less likely to be depressed than those who did not (adjusted odds ratio (aOR) = .43, 95% confidence interval (CI) = [.27, .70]). Lockdown was negatively associated with postpartum depression among postpartum women with low level of social support (aOR = .30, 95% CI = [.18, .51]). COVID-19 lockdown was associated with lower likelihood of postpartum depression, potentially due to increased support from family. Future research is needed to explore targeted interventions to prevent postpartum depression among women from migrant worker families in rural China.

Does public health education improve migrant workers' health status in China?-evidence from China Migrants Dynamic Survey

This study investigates the effect of public health education (PHE) on migrant workers' health status in China, using the data collected from the China Migrants Dynamic Survey project. The analysis employs a probit model, whose results suggest that, in general, PHE has a statistically significant and positive impact on migrant workers' self-rated health status and exerts a negative impact on their incidence rate of daily diseases. We also utilize the conditional mixed process method to address the potential endogenous issue. Further analyses reveal that there are significant differences in the impacts of different modes of PHE on migrant workers' health status, among which the mode of health knowledge lectures plays the most prominent role. Nonetheless, an additional analysis indicates that in addition to PHE, other public health services, such as the establishment of health records, also have a significant effect on the promotion of migrant workers' health status. A disaggregated analysis reveals that this impact is heterogeneous among different generations, genders as well as those with different income levels. The findings shed light on the importance of promoting equal access to public health services.

Do Migrant Residents Really Achieve Health Equity by Obtaining Urban Hukou? A Comparative Study on Health Service Utilization and Urbanization in Central China

Introduction

With more than 120 million rural-to-urban migrants, urbanization of the rural population requires deeply exploration in China.

Objective

This study focused on settled citizens who obtained urban Hukou (household registration) during urbanization and investigated their perceptions of health services in China.

Method

A cross-sectional comparison study with an original, closed questionnaire was conducted in two major cities of Hubei, central China, covering health status and both the satisfaction with and utilization of health services. In total, 863 residents with urban Hukou participated in this study; migrants formed the study group and original city residents formed the control group. Propensity score matching (PSM) was used to reduce choice bias in the analysis steps. Besides basic description of the data, ordinary least squares regression (OLS regression) was used to discover the relationship between basic demographic indicators and health expenditure.

Results

PSM yielded 290 effective pairs for analysis. The results indicated an improvement in health status for migrant residents (study group) with a higher average score of self-reported health status and lower prevalence of chronic diseases than the control group. These scores were also better than the standard urban level in central China. The study group showed a higher clinic visit utility (69.63%), lower hospitalization utility (8.28%), less convenience of health service utility, and lower health expenditure than the control group. For the study group, the biggest difference was observed in satisfaction with health service costs, which was the least improved aspect after they obtained urban Hukou. The regression results demonstrated that age, family size, living expenditures, and marital status impacted health costs in the overall model and the influences of these factors differed between the study and control groups.

Conclusions

Obtaining urban Hukou helps migrant residents to meet their health service needs and receive equal access to health services. However, after obtaining urban Hukou, migrants also face great pressure in terms of health consumption. This study therefore offers guidance on the next steps for progressing China's urbanization.

Migration, Schizophrenia, and Crime: A Study From a Forensic Psychiatric Sample

BACKGROUND

The association between mental health problems and crime in immigrants has attracted recent academic interest, with results suggesting that there were possible interactions between immigration, schizophrenia, and criminal behavior. However, very few studies have examined these interactions, especially in developing countries that have mass internal immigration. Therefore, this study sought to identify the associations between the sociodemographic, clinical, and criminal factors in migrants and non-migrants with schizophrenia who had been involved in criminal activities in China.

METHODS

Forensic archives of suspects who had been referred for criminal responsibility assessments in the Sichuan West China Forensic Center from January 2015 to December 2019 were reviewed. The sociodemographic, and criminal activity information of the suspects were extracted, while the clinical and social function were measured by the Brief Psychiatric Rating Scale (BPRS) and Social Disability Screening Schedule (SDSS) based on the archives. A Chi-squared test, a T-test, a Mann-Whitney U test, and Multinomial logistic regression were employed for the statistical analysis.

RESULTS

A total of 552 patients were reviewed and evaluated, 17.2% (n = 95) of which were migrants. The migrant patient group was younger than the non-migrant patient group. The BPRS and SDSS scores for the migrant patient group were lower than for the non-migrant patient group. The migrant patient group had more work experience and more had been employed at the time of the crime than the non-migrant patient group. The unemployed migrant patients were more likely to commit a property-related crime.

CONCLUSIONS

Compared to the non-migrant schizophrenia patient group, the migrant patient group had less severe psychiatric symptoms and less social function impairments. Employment was an important factor in preventing criminality in patients with schizophrenia, especially for migrant patients. Vocational rehabilitation focuses on developing appropriate employment that can significantly assist in schizophrenia patient recovery, which in turn could reduce their chances of committing crime. Besides, reducing other obstacles to stigma, housing and health insurance would also be beneficial to crime reduction.

Inclusive partnership and community mobilization approaches to improve maternal health care access among internal migrants in nine Indian cities

Background

Disparities in healthcare access to internal migrants exist, and the gaps may widen further if appropriate steps are not taken. Innovative approaches are needed to better align the healthcare services with the migrants’ needs.

Aim

The aim was to develop and test a supportive strategy of healthcare, which would achieve the desired level of access and delivery of maternal healthcare services to internal migrants living in nine Indian cities.

Methods

This intervention with the quasi-experimental design was conducted with pre- vs post-intervention comparisons within the interventional groups and with the control group. The intervention was implemented with an inclusive partnership approach. Advocacy and community mobilization were the main intervention components.

Findings

An increased proportion of women sought antenatal care during the intervention. More women initiated seeking antenatal care in the first trimester. Due to intervention, health workers’ prenatal (41.7% in the post- against 14.7% in the pre-interventional phase) and postnatal home visits increased (11.6% to 34.7%) considerably.

Conclusions

Interventions with inclusive partnership would improve healthcare access to vulnerable communities such as migrants. Hence, efforts to strengthen the government healthcare system through novel strategies are crucial to provide better healthcare to migrants.

Health Disparities: A Perspective on Internal Migration and Health Behavior in Sudan

Background:

Natural hazards, poor socio-economic conditions, low literacy levels, and long-standing conflicts affect traditional gold miners in Sudan and contribute to multiple health vulnerabilities. An extensive survey reveals differential health risk among internal migrant miners leading to short-, medium-, and long-term health consequences and disparities. The need to identify determinants of health behavior and limited prior research on internal migrants involved in traditional gold mining in Sudan motivated this research.

Objective:

To investigate potential health disparities between internal migrant workers participating in traditional gold mining and their local counterparts.

Methods:

Questionnaires on socio-demographic and health status in the Abideya area in the River Nile state of Sudan were administered to 211 miners. Composite score variables were devised based on existing literature and data for assessment of underlying risk determinants for the miners’ vulnerability (migrants and non-migrants). Six new composite variables were constructed and subjected to analysis by immigration status.

Findings:

There are disparities in drivers of health behavior related to the immigration status of traditional gold miners. Access to water, sanitation, and hygiene services are common determinants for the health behavior of both internal migrant miners (p < 0.001) and their local counterparts (p < 0.001). However, knowledge (p < 0.05) and perception (p < 0.05) are additional critical determinants for the health behavior of local miners, while education (secondary, p < 0.01) is an additional modifier for the immigrants’ health behavior.

Conclusions:

The outcomes of this field-based research suggest increased awareness and risk perceptions among migrants could improve health-related behaviors. The study advocates for policymaking and implementation of health programs at all levels to reduce health disparities between migrants and non-migrants, improving the health status of the entire community.

Has Rural-Urban Migration Promoted the Health of Chinese Migrant Workers？

The relationship between health and migration has always been an important theme in immigration research. This research develops a new approach to test the healthy migrant hypothesis and the salmon bias hypothesis in China by examining an interaction term combining agricultural hukou and migrant status, non-agricultural employment history, and subsequent area of residence. Based on two Chinese micro-databases, CGSS 2015 and Harmonized CHARLS, we conducted an empirical test on the relationship between migration and health. Our empirical evidence suggests that the initial health advantage among Chinese rural migrant workers was largely due to self-selection rather than migration effects. After controlling for demographic and socioeconomic characteristics, this advantage disappeared. After their health deteriorated, migrant workers returned to their original location. This could exacerbate the contradiction between the allocation of medical resources and the demand in rural and urban China, further intensifying the already widening health status gap between rural and urban residents.

High Willingness to Participate in Partner Notification among Women Attending Reproductive Health and STI Clinics in Shenzhen, China: A Cross-Sectional Study

Genital Chlamydia trachomatis (CT) is one of the most common sexually transmitted infections (STI) worldwide. We explored the factors associated with willingness to participate in partner notification (PN) among women attending reproductive health and STI clinics in Shenzhen, China. An anonymous questionnaire was used to collect the sociodemographic characteristics, STI histories, and willingness to participate in routine CT screening and partner notification. In total, 87.31% (n = 10,780) of participants were willing to notify their sex partner(s) if they were diagnosed with a CT infection. Willingness to complete PN was significantly associated with: being married, residing in Shenzhen ≥1 year, having completed junior college or higher, not currently reporting STI-related symptoms, willing to have routine CT screening, and having a correct understanding of the health sequelae of CT infection. Nearly all women surveyed at reproductive health and STI clinics in Shenzhen reported willingness to complete PN. Promoting PN in these settings could help detect a large number of additional CT cases. Our findings provide evidence and implications for public health interventions on PN and suggest that targeted interventions are urgently needed for particular subpopulations including those not currently married, with shorter residency, lower education, and less awareness about the dangers of CT infection.

Associations among Socioeconomic Factors, Lag Time, and High-Risk Histopathologic Features in Eyes Primarily Enucleated for Retinoblastoma

Purpose/Aim: To determine the associations among socioeconomic factors, delay in management, and high-risk histopathologic features in eyes primarily enucleated for retinoblastoma. Materials and Methods: A single-site survey was conducted from January 2016 through January 2018. Eyes primarily enucleated for unilateral retinoblastoma were reviewed for the presence of high-risk histopathologic features. Information on clinical characteristics, socioeconomic factors, and lag time were collected during hospitalization. Results: Of the 138 children analyzed, 60 (43.5%) carried high-risk histopathologic features. Compared to children with a standard risk, those with a high risk had a longer median lag time before treatment (21.5 vs 15.0 days, P = .007), but their overall lag time (54.0 vs 50.0 days, P = .062) and delay in the initial visit (7.0 vs 10.0 days, P = .782) were comparable. Logistic regression analysis showed that children with a lag time ≥ 30 days were at a significantly higher risk of extraocular invasion (odds ratio [OR] = 2.38 and 95% confidence interval [CI] = 1.08-5.37 for treatment delay; OR = 2.12 and 95% CI = 1.01-4.62 for overall delay). Neither high-risk histopathologic features nor lag time was associated with any demographic or major socioeconomic factors, including sex, age at diagnosis or enucleation, ethnicity, household income, parents' education level, medical insurance coverage, and left-behind status. Conclusions: For children with advanced unilateral retinoblastoma, there is no statistical difference in overall lag time between standard and high-risk groups. Major socioeconomic parameters have little impact on the delay and histopathologic outcomes, thus implying that children with varied socioeconomic status may be at a similar risk of advanced tumor invasion.

Association between rural-to-urban migrants' social medical insurance, social integration and their medical return in China: a nationally representative cross-sectional data analysis

BACKGROUND

Without social medical insurance in the destination areas and with low social integration, rural-to-urban migrants had barriers to health service in the destination areas, some of the migrants had to seek health service in hometown, namely medical return. This study aimed at exploring the association between rural-to-urban migrants' medical return and social medical insurance type or social integration.

METHODS

We analysed a secondary cross-sectional data of the 2014 National Internal Migrant Dynamic Monitoring Survey collected in May of 2014 from all provinces or regions in mainland China. The medical return was measured by the location of hospitalisation, and the social integration included economic integration and permanent settlement intention.

RESULTS

Four thousand eighteen rural-to-urban migrants living in current residence at least one year and used inpatient service within the last 12 months were analysed. The rate of medical return for inpatient service was 15.3%. Having medical insurance of hometown (new rural cooperative medical scheme (NRCMS)) (OR = 2.44, 95%CIs 1.80-3.30) was positively related to the medical return. The permanent settlement intention was negatively associated with the medical return (OR = 0.66, 95%CIs 0.48-0.90).

CONCLUSIONS

Social medical insurance of hometown (NRCMS) was positively associated with the medical return, while the permanent settlement intention was negatively associated with it. Promoting the transfer of migrants' social medical insurance across different regions might be helpful to improve rural-to-urban migrants' health access.

Association between acculturation and body weight status among migrant children in Guangzhou, China: a cross-sectional study

OBJECTIVE

To assess the association between acculturation and body weight status among internal migrant children in China.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study was conducted among 1154 pairs of migrant children aged 11-17 years and their primary caregivers in Guangzhou, China, from April to May 2016.

MEASURES

Migrant children's body weight status was measured by body mass index. Acculturation was measured by a questionnaire, developed and validated by the research team. The questionnaire had three dimensions with five factors, namely language, social interaction, custom, dressing and diet. Social anxiety was measured by Social Anxiety Scale for Children. Food intake was measured by the food frequency table that was developed from a previous study. Logistic regression was performed to examine the association between acculturation and overweight/obesity while controlling for migrant children's and their caregivers' demographic characteristics, children's social anxiety and food intake.

RESULTS

Seventy-six out of 1154 (6.6%) migrant children were overweight, and 36 (3.1%) were obese. The overall prevalence of overweight/obesity was 12.5% in boys, and 6.1% in girls (p<0.001), respectively. The mean scores of acculturation were 41.8 (SD=14.6). Migrant children had the highest level of acculturation in the aspect of dressing (mean=61.7, SD=16.6), followed by language (mean=47.9, SD=22.3), diet (mean=45.0, SD=18.5), social interaction (mean=42.4, SD=21.3) and custom (mean=27.6, SD=19.2). After controlling for confounding factors, the levels of acculturation was negatively associated with overweight/obesity (adjusted OR (aOR)=0.98, 95% CI 0.97 to 1.00, p=0.030). Furthermore, migrant children who had urban-to-urban migrant caregivers were more likely to be overweight/obese (aOR=2.07, 95% CI 1.16 to 3.69, p=0.014) than their counterparts living with rural-to-urban migrant caregivers.

CONCLUSIONS

The low levels of acculturation was associated with overweight/obesity among migrant children in Guangzhou, China. Promoting healthy acculturation and social campaign on healthy body weight may help prevent childhood overweight/obesity. Young migrant children, boys and children living with urban-to-urban migrant caregivers should be the target subgroups.

Times series analysis of age-specific tuberculosis at a rapid developing region in China, 2011-2016

The city of Shenzhen has recently experienced extraordinary economic growth accompanied by a huge internal migrant influx. We investigated the local dynamics of tuberculosis (TB) epidemiology in the Nanshan District of Shenzhen to provide insights for TB control strategies for this district and other rapidly developing regions in China. We analyzed the age-specific incidence and number of TB cases in the Nanshan District from 2011 to 2016. Over all, the age-standardized incidence of TB decreased at an annual rate of 3.4%. The incidence was lowest amongst the age group 0-14 and showed no increase in this group over the six-year period (P = 0.587). The fastest decreasing incidence was among the 15-24 age group, with a yearly decrease of 13.3% (β = 0.867, P < 0.001). In contrast, the TB incidence increased in the age groups 45-54, 55-54, and especially in those aged ≥65, whose yearly increase was 13.1% (β = 1.131, P < 0.001). The peak time of TB case presentation was in April, May, and June for all age groups, except in August for the 45-54 cohort. In the rapidly developing Nanshan District, TB control policies targeted to those aged 45 years and older should be considered. The presentation of TB cases appears to peak in the spring months.

The prevalence, age-of-onset and the correlates of DSM-IV psychiatric disorders in the Tianjin Mental Health Survey (TJMHS)

BACKGROUND

To effectively shape mental healthcare policy in modern-day China, up-to-date epidemiological data on mental disorders is needed. The objective was to estimate the prevalence, age-of-onset (AOO) and sociodemographic correlates of mental disorders in a representative household sample of the general population (age ⩾ 18) in the Tianjin Municipality in China.

METHODS

Data came from the Tianjin Mental health Survey (TJMHS), which was conducted between July 2011 and March 2012 using a two-phase design. 11 748 individuals were screened with an expanded version of the General Health Questionnaire and 4438 subjects were selected for a diagnostic interview by a psychiatrist, using the Structured Clinical Interview for the Diagnostic and Statistical Manual - fourth edition (SCID).

RESULTS

The lifetime and 1-month prevalence of any mental disorder were 23.6% and 12.8%, respectively. Mood disorders (lifetime: 9.3%; 1-month: 3.9%), anxiety disorders (lifetime: 4.5% 1-month: 3.1%) and substance-use disorders (lifetime: 8.8%; 1-month: 3.5%) were most prevalent. The median AOO ranged from 25 years [interquartile range (IQR): 23-32] for substance-use disorders to 36 years (IQR: 24-50) for mood disorders. Not being married, non-immigrant status (i.e. local 'Hukou'), being a farmer, having <6 years of education and male gender were associated with a higher lifetime prevalence of any mental disorder.

CONCLUSION

Results from the current survey indicate that mental disorders are steadily reported more commonly in rapidly-developing urban China. Several interesting sociodemographic correlates were observed (e.g. male gender and non-immigrant status) that warrant further investigation and could be used to profile persons in need of preventive intervention.

Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study

OBJECTIVES

To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation.

DESIGN

Cross-sectional survey between April and May 2016.

SETTING

Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China.

PARTICIPANTS

We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year.

MAIN OUTCOME MEASURES

The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups).

RESULTS

In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status.

CONCLUSIONS

Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.

Should the poor have no medicines to cure? A study on the association between social class and social security among the rural migrant workers in urban China

Background

The rampant urbanization and medical marketization in China have resulted in increased vulnerabilities to health and socioeconomic disparities among the rural migrant workers in urban China. In the Chinese context, the socioeconomic characteristics of rural migrant workers have attracted considerable research attention in the recent past years. However, to date, no previous studies have explored the association between the socioeconomic factors and social security among the rural migrant workers in urban China. This study aims to explore the association between socioeconomic inequity and social security inequity and the subsequent associations with medical inequity and reimbursement rejection.

Methods

Data from a regionally representative sample of 2009 Survey of Migrant Workers in Pearl River Delta in China were used for analyses. Multiple logistic regressions were used to analyze the impacts of socioeconomic factors on the eight dimensions of social security (sick pay, paid leave, maternity pay, medical insurance, pension insurance, occupational injury insurance, unemployment insurance, and maternity insurance) and the impacts of social security on medical reimbursement rejection. The zero-inflated negative binomial regression model (ZINB regression) was adopted to explore the relationship between socioeconomic factors and hospital visits among the rural migrant workers with social security.

Results

The study population consisted of 848 rural migrant workers with high income who were young and middle-aged, low-educated, and covered by social security. Reimbursement rejection and abusive supervision for the rural migrant workers were observed. Logistic regression analysis showed that there were significant associations between socioeconomic factors and social security. ZINB regression showed that there were significant associations between socioeconomic factors and hospital visits among the rural migrant workers. Also, several dimensions of social security had significant associations with reimbursement rejections.

Conclusions

This study showed that social security inequity, medical inequity, and reimbursement inequity happened to the rural migrant workers simultaneously. Future policy should strengthen health justice and enterprises’ medical responsibilities to the employed rural migrant workers.

Electronic supplementary material

The online version of this article (10.1186/s12939-017-0692-x) contains supplementary material, which is available to authorized users.

Observed prevalence and risk factors of birth defects in Shanghai, China

AIM

To investigate the prevalence and related risk factors of birth defects in Shanghai.

METHODS

This report describes a population-based study of all births at the Obstetrics and Gynecology Hospital of Fudan University in Shanghai, China from January 2008 to December 2014. A logistic regression analysis was used to identify the parameters that are independently associated with birth defects.

RESULTS

A total of 82814 births, including 824 cases of birth defects, were recorded. The rate of birth defects was 0.995 per 100 births. In the multivariable regression analysis, neonatal birth defects were likely to be associated with higher gravidity [odds ratio (OR), 1.099, 95%CI: 1.024-1.178], premature birth (OR = 1.905, 95%CI: 1.501-2.418), low birth weight (OR = 3.844, 95%CI: 3.004-4.919), twin births or higher order multiple pregnancies (OR = 1.477, 95%CI: 1.107-1.969), cesarean delivery (OR = 1.184, 95%CI: 1.016-1.380) and registration as part of a migrant population (OR = 1.380, 95%CI: 1.167-1.632). Female infants were less likely to have birth defects than male infants (OR = 0.710, 95%CI: 0.616-0.818).

CONCLUSION

Higher gravidity, premature birth, lower birth weight, twin births or higher order multiple pregnancies, and registration as part of a migrant population are independent predictors of birth defects.

Mapping internal connectivity through human migration in malaria endemic countries

Human mobility continues to increase in terms of volumes and reach, producing growing global connectivity. This connectivity hampers efforts to eliminate infectious diseases such as malaria through reintroductions of pathogens, and thus accounting for it becomes important in designing global, continental, regional, and national strategies. Recent works have shown that census-derived migration data provides a good proxy for internal connectivity, in terms of relative strengths of movement between administrative units, across temporal scales. To support global malaria eradication strategy efforts, here we describe the construction of an open access archive of estimated internal migration flows in endemic countries built through pooling of census microdata. These connectivity datasets, described here along with the approaches and methods used to create and validate them, are available both through the WorldPop website and the WorldPop Dataverse Repository.

Urbanization and health in China, thinking at the national, local and individual levels

BACKGROUND

China has the biggest population in the world, and has been experiencing the largest migration in history, and its rapid urbanization has profound and lasting impacts on local and national public health. Under these conditions, a systems understanding on the correlation among urbanization, environmental change and public health and to devise solutions at national, local and individual levels are in urgent need.

METHODS

In this paper, we provide a comprehensive review of recent studies which have examined the relationship between urbanization, urban environmental changes and human health in China. Based on the review, coupled with a systems understanding, we summarize the challenges and opportunities for promoting the health and wellbeing of the whole nation at national, local, and individual levels.

RESULTS

Urbanization and urban expansion result in urban environmental changes, as well as residents' lifestyle change, which can lead independently and synergistically to human health problems. China has undergone an epidemiological transition, shifting from infectious to chronic diseases in a much shorter time frame than many other countries. Environmental risk factors, particularly air and water pollution, are a major contributing source of morbidity and mortality in China. Furthermore, aging population, food support system, and disparity of public service between the migrant worker and local residents are important contributions to China's urban health.

CONCLUSIONS

At the national level, the central government could improve current environmental policies, food safety laws, and make adjustments to the health care system and to demographic policy. At the local level, local government could incorporate healthy life considerations in urban planning procedures, make improvements to the local food supply, and enforce environmental monitoring and management. At the individual level, urban residents can be exposed to education regarding health behaviour choices while being encouraged to take responsibility for their health and to participate in environmental monitoring and management.

Congenital Heart Disease in Local and Migrant Elementary Schoolchildren in Dongguan, China

The aim of this study was to determine the prevalence and treated status of congenital heart disease (CHD) in elementary schoolchildren and facilitate the long-term planning of health care, resource allocation, and development of targeted primary prevention strategies. From November 2011 to November 2012, 540,574 schoolchildren from 449 elementary schools were screened for CHD by trained doctors in Dongguan City. The schoolchildren who were suspected to have CHD were referred to a pediatric cardiologist and/or an echocardiographist for complete evaluation. Of them, 214,634 (39.7%) were local children and 325,940 (60.3%) were migrant children. The total prevalence of CHD was 2.14‰, and there was a significant difference (p <0.05) of the CHD prevalence between local (1.97‰) and migrant children (2.26‰). The treatment rates of CHD in local children and in migrant children were 63.51% and 47.21%, respectively (p <0.01). The commonest CHD was ventricular septal defect (43.13%), followed by atrial septal defect (25.84%) and patent ductus arteriosus (12.79%). With respect to gender, CHD was equally distributed between men and women. In conclusion, social, economic, and environmental risk factors that affect health of migrant children with CHD call for more attention from health policy makers and researchers in contemporary China. Efforts should be made to increase public health investment, establish health care manage system for children from migrant families, and increase the parents' awareness of preventing the CHD.