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Chen Z, Tang X, Xu C, Wang C, Ling L. Exploring factors jointly associated with recurrent relapse and dropout of methadone maintenance treatment clients in Guangdong, China: A retrospective cohort study. Drug Alcohol Depend 2023; 243:109739. [PMID: 36535097 DOI: 10.1016/j.drugalcdep.2022.109739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Clients receiving methadone maintenance treatment (MMT) may experience multiple relapses, which may lead to dropout. However, previous studies mostly only explored the influencing factors of relapse or dropout separately. In this study, we investigated the influencing factors jointly associated with both recurrent relapse and dropout. METHODS This study was conducted in 16 MMT clinics in Guangdong, China. Data on the clients' demographic characteristics; drug-related behavior; HIV, HCV, and urine morphine test results; and daily methadone doses were collected. The outcomes were time to recurrent relapse and time to dropout. A joint frailty model was used to explore factors jointly associated with recurrent relapse and dropout. The hazard ratios (HRs) of the covariates in the multivariable model were adjusted, with HR > 1 indicating a faster time to recurrent relapse and dropout. RESULTS Among 1539 clients, 39.5% had ≥ 2 relapse events, and 90.8% of the clients dropped out. A high attendance rate was protective for recurrent relapse (HR50-80%=0.63, 95% CI: 0.51, 0.79; HR>80%=0.35, 95% CI: 0.28, 0.44) and dropout (HR50-80%=0.56, 95% CI: 0.47, 0.68; HR>80%=0.27, 95% CI: 0.23, 0.33). Being married (HR=0.80, 95% CI: 0.67, 0.96), having a fair relationship with family (HR=0.79, 95% CI: 0.67, 0.93) and drug injection (HR=0.80, 95% CI: 0.67, 0.96) were also protective for recurrent relapse. Female (HR=0.64, 95% CI: 0.50, 0.82) and a high methadone dose (≥60 ml/day; HR=0.79, 95% CI: 0.65, 0.96) were protective for dropout, and a longer traveling time to the clinic (>60 min; HR=1.59, 95% CI: 1.20, 2.10) was associated with an increased risk of dropout. CONCLUSIONS It is common for clients to experience recurrent relapse and dropout. The findings suggest that MMT clinics should provide holistic interventions and appropriate methadone doses for clients to improve treatment compliance.
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Affiliation(s)
- Zouxiang Chen
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Xijia Tang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Chaofan Xu
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Chijie Wang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China
| | - Li Ling
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong 510120 , PR China; Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
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Yuan JM, Croxford S, Viviani L, Emanuel E, Phipps E, Desai M. Investigating the sociodemographic and behavioural factors associated with hepatitis C virus testing amongst people who inject drugs in England, Wales and Northern Ireland: A quantitative cross-sectional analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103821. [PMID: 35994940 DOI: 10.1016/j.drugpo.2022.103821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) transmission in the UK is driven by injecting drug use. We explore HCV testing uptake amongst people who inject drugs (PWID) in England, Wales and Northern Ireland, and identify factors associated with i) ever having an HCV test amongst people who have ever injected drugs, and ii) recently having an HCV test (within the current or previous year) amongst people who currently inject drugs (reported injecting drugs within the last year). METHODS We analysed data from the 2019 'Unlinked Anonymous Monitoring Survey' of PWID, using logistic regression. RESULTS Of 3,127 PWID, 2,065 reported injecting drugs within the last year. Most (86.7%) PWID had a lifetime history of HCV testing. In multivariable analysis, higher odds of ever testing were associated with: female sex (aOR=1.54; 95%CI 1.11-2.14), injecting duration ≥3 years (aOR=2.94; 95%CI 2.13-4.05), ever receiving used needles/syringes (aOR=1.74; 95%CI 1.29-2.36), ever being on opioid agonist treatment (aOR=2.91; 95%CI 2.01-4.21), ever being imprisoned (aOR=1.86; 95%CI 1.40-2.48) and ever being homeless (aOR=1.54; 95%CI 1.14-2.07). Amongst PWID who had injected drugs within the last year, 49.9% had recently undertaken an HCV test. After adjustment, factors associated with higher odds of undertaking a recent HCV test included: injecting crack in the last year (aOR=1.29; 95%CI 1.03-1.61), experiencing a non-fatal overdose in the last year (aOR=1.39; 95%CI 1.05-1.85), ever being on opioid agonist treatment (aOR=1.48; 95%CI 0.97-2.25), receiving HCV information in the last year (aOR=1.99; 95%CI 1.49-2.65) and using a healthcare service in the last year (aOR=1.80; 95%CI 1.21-2.67). CONCLUSION Results suggest that PWID who have experienced homelessness and incarceration - amongst the most vulnerable and marginalised in the PWID population - are engaging with HCV testing, but overall there remain missed testing opportunities. Recent initiates to injecting have highest HCV infection risk but lower odds of testing, and peer-education may help target this group.
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Affiliation(s)
- Jin-Min Yuan
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Sara Croxford
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Laura Viviani
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Eva Emanuel
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Emily Phipps
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Monica Desai
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
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Systematic Review of Hepatitis C Virus Prevalence in the WHO Western Pacific Region. Viruses 2022; 14:v14071548. [PMID: 35891529 PMCID: PMC9320901 DOI: 10.3390/v14071548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This review aimed to identify hepatitis C virus (HCV) prevalence estimates among the general population and six key populations (people who inject drugs, men who have sex with men, sex workers, prisoners/detainees, Indigenous people, and migrants) in the World Health Organization Western Pacific Region (WHO WPR). METHODS Original research articles published between 2016 and 2020 were identified from bibliographic databases. Publications were retrieved, replicas removed, and abstracts screened. Retained full texts were assessed and excluded if inclusion criteria were not met. Methodological quality was assessed using the Johanna Briggs Institute critical appraisal checklist for prevalence data. Data on HCV exposure and active infection were extracted and aggregated and forest plots generated for each population by country. RESULTS There were no HCV prevalence estimates in any population for more than half of WPR countries and territories. Among the 76 estimates, 97% presented prevalence of exposure and 33% prevalence of active infection. General population viraemic prevalence was 1% or less, except in Mongolia. Results confirm the endemic nature of HCV among people who inject drugs, with estimates of exposure ranging from 30% in Cambodia to 76% in Hong Kong. CONCLUSIONS Countries require detailed knowledge of HCV prevalence in diverse populations to evaluate the impact of efforts to support WHO HCV elimination goals. Results provide baseline estimates from which to monitor and evaluate progress and by which to benchmark future elimination efforts.
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Fan X, Zhang X, Xu H, Yang F, Lau JT, Hao C, Li J, Zhao Y, Hao Y, Gu J. Effectiveness of a Psycho-Social Intervention Aimed at Reducing Attrition at Methadone Maintenance Treatment Clinics: A Propensity Score Matching Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224337. [PMID: 31703302 PMCID: PMC6888175 DOI: 10.3390/ijerph16224337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022]
Abstract
Methadone maintenance treatment (MMT) is an important approach to address opioid dependence. However, MMT clinics usually report high attrition rates. Our previous randomized controlled trial demonstrated additional psycho-social services delivered by social workers could reduce attrition rates compared to MMT alone. This study aimed to evaluate the effectiveness of psycho-social service in a real-world context. A quasi-experimental design and propensity score matching was adopted. 359 clients were recruited from five MMT clinics in Guangzhou from July 2013 to April 2015. One 20-minute counseling session was offered to the control group after enrolment. The intervention group received six sessions of psycho-social services. The baseline characteristics were unbalanced between two arms in the original sample. After propensity score matching, 248 participants remained in the analysis. At month six, the intervention group had a lower attrition rate [intervention (39.5%) versus control (52.4%), P = 0.041], higher monthly income [monthly income of 1000 CNY or higher: intervention (55.9%) versus control (39.0%), P = 0.028)], higher detoxification intention score [full intention score: intervention (51.6%) versus control (32.5%), P = 0.012)], higher family support in MMT participation [intervention (77.9%) versus control (61.4%), P = 0.049)]. This study demonstrated that psycho-social services delivered by social workers can reduce MMT clients’ attrition and improve their well-being in real-world settings.
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Affiliation(s)
- Xiaoyan Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; (X.F.); (X.Z.); (C.H.); (J.L.); (Y.H.)
| | - Xiao Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; (X.F.); (X.Z.); (C.H.); (J.L.); (Y.H.)
- Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China
| | - Huifang Xu
- Guangzhou Centre for Disease Prevention and Control, Guangzhou 510080, Guangdong, China; (H.X.); (Y.Z.)
| | - Fan Yang
- Institute for Global Health and Infectious Diseases, University of North Carolina, Project-China, Guangzhou 510080, Guangdong, China;
| | - Joseph T.F. Lau
- Centre for Medical Anthropology and Behavioural Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China;
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; (X.F.); (X.Z.); (C.H.); (J.L.); (Y.H.)
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; (X.F.); (X.Z.); (C.H.); (J.L.); (Y.H.)
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Yuteng Zhao
- Guangzhou Centre for Disease Prevention and Control, Guangzhou 510080, Guangdong, China; (H.X.); (Y.Z.)
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; (X.F.); (X.Z.); (C.H.); (J.L.); (Y.H.)
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China; (X.F.); (X.Z.); (C.H.); (J.L.); (Y.H.)
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- Correspondence: ; Tel.: +86-136-6001-7090
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Liu W, Jiang X, Liu Y, Ma Q. Bioinformatics Analysis of Quantitative PCR and Reverse Transcription PCR in Detecting HCV RNA. Curr Bioinform 2019. [DOI: 10.2174/1574893613666180703103328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective:This research aimed to make comparisons of sensitivity and specificity between Quantitative real Time Polymerase Chain Reaction (Q-PCR) and Reverse Transcription PCR (RT-PCR) in detecting the ribonucleic acid (RNA) expression levels of Hepatitis C Virus (HCV).Methods:121 patients suffering from hepatitis C and 98 healthy participants with normal liver functions were identified. The venous blood collections were carried out, were subjected to detect the expression levels of HCV RNA via Q-PCR and RT-PCR. And then, the data obtained from these above two detection methods were compared, including the sensitivity and specificity.Results:In terms of Q-PCR, the positive rate of HCV RNA was 72.16%, which was significantly higher when compared with 55.26% of RT-PCR. After statistical analysis, the difference between them was statistically significant (P<0.05). Among the healthy participants, 4 cases were false positive by means of RT-PCR, there was the possibility of missed diagnosis when the samples were evaluated by Q-PCR.Conclusion:: The Q-PCR detection technology performed well in testing HCV, with pretty high sensitivity and specificity. Nevertheless, the false negative results obtained from Q-PCR could not be avoided. In clinical practice, these above two detection methods should be referred to, in order to avoid missed diagnosis.
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Affiliation(s)
- Wei Liu
- Luhe Hospital Capital Medical University, Beijing, China
| | - Xiwen Jiang
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, Guangdong, China
| | - Yue Liu
- DAAN Gene Co., Ltd. of Sun Yat-sen University, 19 Xiangshan Road, Science Park, High & New Technology Development District, Guangzhou, Guangdong, China
| | - Qingsong Ma
- Qian'an Traditional Chinese Medicine Hospital, 66 Foshan Road, Qian'an, Hebei, China
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Cao S, Liu F, Wang T, Tan Y, Liu S, Liu Y, Gao L, Chen L. New patterns emerge after a sustained increase in the incidence of hepatitis C virus infection from 2004 to 2017: a joinpoint regression analysis. Public Health 2019; 170:49-56. [PMID: 30928613 DOI: 10.1016/j.puhe.2019.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/02/2019] [Accepted: 01/18/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) infection continues to be a major public health concern in China. There is little information available in the literature about age- and sex-specific HCV incidence trends. The goal of this study was to examine recent trends in HCV incidence rates in Hunan, China, according to age and gender. STUDY DESIGN A descriptive study was implemented with a joinpoint analysis. METHODS Based on the annual reported incidence data of hepatitis C in Hunan, China, from 2004 to 2017, we performed a joinpoint regression analysis to examine trends in the annual percentage change (APC) and the average annual percentage change (AAPC) in the incidence of HCV infection throughout the study period; we stratified the analysis by gender and age. The software calculates the APC, AAPC and the 95% confidence intervals for each trend segment and tests whether the slope for each segment has a significant difference from the prior segment using a Z test. RESULTS From 2004 to 2017, the overall incidence rate of HCV infection rose from 0.93 per 100,000 to 20.88 per 100,000 (AAPC, 25.2%). In particular, women aged ≥65 years had the fastest increasing rate (AAPC, 29.9%). The incidence of different demographic groups showed no significant difference in increasing trends before 2013. However, new patterns emerged after 2013: the incidence of people aged 0-14 years was no longer significantly elevated; a significant yearly decline occurred in the incidence of HCV in people aged 15-29 years; the incidence of HCV in people aged ≥30 years continued to increase, with significantly slower increasing rates than before; and women aged ≥65 years showed a significantly higher yearly increase in incidence than that in men in the same age group (APC, 11.1% in women versus 5.3% in men). CONCLUSION The overall increasing rate of HCV infection significantly slowed after 2007 and 2013. The differences in incidence trends among demographic groups have obviously increased in the last 5 years, and the reasons underlying these different trends urgently require further study. People in older age groups, especially women aged ≥65 years, still experienced increases in incidence rates in the last 5 years. This finding indicates that programmes for the prevention and control of HCV infection in older people require continued strengthening.
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Affiliation(s)
- Shiyu Cao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, 410078, China
| | - Fuqiang Liu
- Department of Public Health Emergency Treatment, Hunan Center for Disease Control and Prevention (CDC), Changsha, Hunan Province, 410005, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, 410078, China
| | - Yaqing Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, 410078, China
| | - Shujun Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, 410078, China
| | - Yuan Liu
- Department of Chronic Disease Control and Prevention, Hunan Center for Disease Control and Prevention (CDC), Changsha, Hunan Province, 410005, China
| | - Lidong Gao
- Department of Public Health Emergency Treatment, Hunan Center for Disease Control and Prevention (CDC), Changsha, Hunan Province, 410005, China.
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, 410078, China.
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Zou X, Xu Y, Chen W, Xia Y, Liu Y, Gong C, Ling L. Strategies to control HIV and HCV in methadone maintenance treatment in Guangdong Province, China: a system dynamic modeling study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:1. [PMID: 29321039 PMCID: PMC5763976 DOI: 10.1186/s13011-017-0140-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/27/2017] [Indexed: 12/31/2022]
Abstract
Background Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among methadone maintenance treatment (MMT) participants remain high. Optimized HIV and HCV prevention strategies for MMT clinics in resource-limited regions are urgently needed. This study aims to develop an MMT system dynamic model (SDM) to compare and optimize HIV and HCV control strategies in the MMT system. Methods We developed an MMT-SDM structure based on literature reviews. Model parameters were estimated from a cohort study, cross-sectional surveys and literature reviews. We further calibrated model outputs to historical data of HIV and HCV prevalence among MMT participants in 13 MMT clinics of Guangdong Province. Lastly, we simulated the impact of integrated interventions on HIV and HCV incidence among MMT participants using the MMT-SDM. Results The MMT-SDM comprises MMT clinics, MMT participants, detoxification centers, and HIV and HCV transmission, testing and treatment systems. We determined that condom promotion was the most effective way to reduce HIV infection (2013-2020: 2.86% to 1.76%) in MMT setting, followed by needle exchange program (2013-2020: 2.86% to 2.56%), psychological counseling (2013-2020: 2.86% to 2.71%) and contingency management (2013-2020: 2.86% to 2.72%). Health education had marginal impact on reducing HIV incidence among MMT participants (2013-2020:2.86% to 2.84%) from 2013 to 2020. By contrast, psychological counseling (2013-2020: 7.54% to 2.42%) and contingency management (2013-2020: 7.54% to 2.96%) had been shown to be the most effective interventions to reduce HCV incidence among MMT participants, followed by needle exchange program (2013-2020: 7.54% to 5.76%), health education (2013-2020: 7.54% to 6.35%), and condom promotion program (2013-2020: 7.54% to 6.40%). Notably, HCV treatment reduced HCV incidence by 0.32% (2013-2020: 7.54% to 7.22%). Conclusions In conclusion, we generated a valuable system dynamic model to analyze the Chinese MMT system and to guide the decision-making process to further improve this system. This study underscores the importance of promoting condom use in MMT clinics and integrating psychosocial interventions to reduce HIV and HCV infections in MMT clinics in China. Electronic supplementary material The online version of this article (10.1186/s13011-017-0140-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xia Zou
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yong Xu
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yinghua Xia
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yin Liu
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Cheng Gong
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China. .,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China.
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