Which urban migrants default from tuberculosis treatment in Shanghai, China?

Jing Chen, Lihong Qi, Zhen Xia, Mei Shen, Xin Shen, Jian Mei, Kathryn DeRiemer, Zheng'an Yuan

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Migration is a major challenge to tuberculosis (TB) control worldwide. TB treatment requires multiple drugs for at least six months. Some TB patients default before completing their treatment regimen, which can lead to ongoing infectiousness and drug resistance. Methods: We conducted a retrospective analysis of 29,943 active TB cases among urban migrants that were reported between 2000 to 2008 in Shanghai, China. We used logistic regression models to identify factors independently associated with treatment defaults in TB patients among urban migrants during 2005-2008. Results: Fifty-two percent of the total TB patients reported in Shanghai during the study period were among urban migrants. Three factors increased the odds of a treatment default: case management using self-administered therapy (OR, 5.84, 95% CI, 3.14-10.86, p<0.0005), being a retreatment case (OR, 1.47, 95% CI, 1.25-1.71, p<0.0005), and age >60 years old (OR, 1.33, 95% CI, 1.05-1.67, p=0.017). The presence of a cavity in the initial chest radiograph decreased the odds for a treatment default (OR, 0.87, 95% CI, 0.77-0.97, p=0.015), as did migration from central China (OR, 0.85, 95% CI, 0.73-0.99, p=0.042), case management by family members (OR, 0.73, 95% CI 0.66-0.81, p<0.0005), and the combination of case detection by a required physical exam and case management by health care staff (OR, 0.64, 95% CI, 0.45-0.93, p=0.019). Conclusion: Among TB patients who were urban migrants in Shanghai, case management using self-administered therapy was the strongest modifiable risk factor that was independently associated with treatment defaults. Interventions that target retreated TB cases could also reduce treatment defaults among urban migrants. Health departments should develop effective measures to prevent treatment defaults among urban migrants, to ensure completion of therapy among urban migrants who move between cities and provinces, and to improve reporting of treatment outcomes.

Original languageEnglish (US)
Article numbere81351
JournalPLoS One
Volume8
Issue number11
DOIs
StatePublished - Nov 28 2013

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tuberculosis
China
Tuberculosis
Case Management
Therapeutics
Health care
Pharmaceutical Preparations
therapeutics
Logistics
Health
Logistic Models
drug resistance
chest
health services
risk factors
Drug Resistance
drugs
Thorax
Delivery of Health Care

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Which urban migrants default from tuberculosis treatment in Shanghai, China? / Chen, Jing; Qi, Lihong; Xia, Zhen; Shen, Mei; Shen, Xin; Mei, Jian; DeRiemer, Kathryn; Yuan, Zheng'an.

In: PLoS One, Vol. 8, No. 11, e81351, 28.11.2013.

Research output: Contribution to journalArticle

Chen, J, Qi, L, Xia, Z, Shen, M, Shen, X, Mei, J, DeRiemer, K & Yuan, Z 2013, 'Which urban migrants default from tuberculosis treatment in Shanghai, China?', PLoS One, vol. 8, no. 11, e81351. https://doi.org/10.1371/journal.pone.0081351
Chen, Jing ; Qi, Lihong ; Xia, Zhen ; Shen, Mei ; Shen, Xin ; Mei, Jian ; DeRiemer, Kathryn ; Yuan, Zheng'an. / Which urban migrants default from tuberculosis treatment in Shanghai, China?. In: PLoS One. 2013 ; Vol. 8, No. 11.
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abstract = "Background: Migration is a major challenge to tuberculosis (TB) control worldwide. TB treatment requires multiple drugs for at least six months. Some TB patients default before completing their treatment regimen, which can lead to ongoing infectiousness and drug resistance. Methods: We conducted a retrospective analysis of 29,943 active TB cases among urban migrants that were reported between 2000 to 2008 in Shanghai, China. We used logistic regression models to identify factors independently associated with treatment defaults in TB patients among urban migrants during 2005-2008. Results: Fifty-two percent of the total TB patients reported in Shanghai during the study period were among urban migrants. Three factors increased the odds of a treatment default: case management using self-administered therapy (OR, 5.84, 95{\%} CI, 3.14-10.86, p<0.0005), being a retreatment case (OR, 1.47, 95{\%} CI, 1.25-1.71, p<0.0005), and age >60 years old (OR, 1.33, 95{\%} CI, 1.05-1.67, p=0.017). The presence of a cavity in the initial chest radiograph decreased the odds for a treatment default (OR, 0.87, 95{\%} CI, 0.77-0.97, p=0.015), as did migration from central China (OR, 0.85, 95{\%} CI, 0.73-0.99, p=0.042), case management by family members (OR, 0.73, 95{\%} CI 0.66-0.81, p<0.0005), and the combination of case detection by a required physical exam and case management by health care staff (OR, 0.64, 95{\%} CI, 0.45-0.93, p=0.019). Conclusion: Among TB patients who were urban migrants in Shanghai, case management using self-administered therapy was the strongest modifiable risk factor that was independently associated with treatment defaults. Interventions that target retreated TB cases could also reduce treatment defaults among urban migrants. Health departments should develop effective measures to prevent treatment defaults among urban migrants, to ensure completion of therapy among urban migrants who move between cities and provinces, and to improve reporting of treatment outcomes.",
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T1 - Which urban migrants default from tuberculosis treatment in Shanghai, China?

AU - Chen, Jing

AU - Qi, Lihong

AU - Xia, Zhen

AU - Shen, Mei

AU - Shen, Xin

AU - Mei, Jian

AU - DeRiemer, Kathryn

AU - Yuan, Zheng'an

PY - 2013/11/28

Y1 - 2013/11/28

N2 - Background: Migration is a major challenge to tuberculosis (TB) control worldwide. TB treatment requires multiple drugs for at least six months. Some TB patients default before completing their treatment regimen, which can lead to ongoing infectiousness and drug resistance. Methods: We conducted a retrospective analysis of 29,943 active TB cases among urban migrants that were reported between 2000 to 2008 in Shanghai, China. We used logistic regression models to identify factors independently associated with treatment defaults in TB patients among urban migrants during 2005-2008. Results: Fifty-two percent of the total TB patients reported in Shanghai during the study period were among urban migrants. Three factors increased the odds of a treatment default: case management using self-administered therapy (OR, 5.84, 95% CI, 3.14-10.86, p<0.0005), being a retreatment case (OR, 1.47, 95% CI, 1.25-1.71, p<0.0005), and age >60 years old (OR, 1.33, 95% CI, 1.05-1.67, p=0.017). The presence of a cavity in the initial chest radiograph decreased the odds for a treatment default (OR, 0.87, 95% CI, 0.77-0.97, p=0.015), as did migration from central China (OR, 0.85, 95% CI, 0.73-0.99, p=0.042), case management by family members (OR, 0.73, 95% CI 0.66-0.81, p<0.0005), and the combination of case detection by a required physical exam and case management by health care staff (OR, 0.64, 95% CI, 0.45-0.93, p=0.019). Conclusion: Among TB patients who were urban migrants in Shanghai, case management using self-administered therapy was the strongest modifiable risk factor that was independently associated with treatment defaults. Interventions that target retreated TB cases could also reduce treatment defaults among urban migrants. Health departments should develop effective measures to prevent treatment defaults among urban migrants, to ensure completion of therapy among urban migrants who move between cities and provinces, and to improve reporting of treatment outcomes.

AB - Background: Migration is a major challenge to tuberculosis (TB) control worldwide. TB treatment requires multiple drugs for at least six months. Some TB patients default before completing their treatment regimen, which can lead to ongoing infectiousness and drug resistance. Methods: We conducted a retrospective analysis of 29,943 active TB cases among urban migrants that were reported between 2000 to 2008 in Shanghai, China. We used logistic regression models to identify factors independently associated with treatment defaults in TB patients among urban migrants during 2005-2008. Results: Fifty-two percent of the total TB patients reported in Shanghai during the study period were among urban migrants. Three factors increased the odds of a treatment default: case management using self-administered therapy (OR, 5.84, 95% CI, 3.14-10.86, p<0.0005), being a retreatment case (OR, 1.47, 95% CI, 1.25-1.71, p<0.0005), and age >60 years old (OR, 1.33, 95% CI, 1.05-1.67, p=0.017). The presence of a cavity in the initial chest radiograph decreased the odds for a treatment default (OR, 0.87, 95% CI, 0.77-0.97, p=0.015), as did migration from central China (OR, 0.85, 95% CI, 0.73-0.99, p=0.042), case management by family members (OR, 0.73, 95% CI 0.66-0.81, p<0.0005), and the combination of case detection by a required physical exam and case management by health care staff (OR, 0.64, 95% CI, 0.45-0.93, p=0.019). Conclusion: Among TB patients who were urban migrants in Shanghai, case management using self-administered therapy was the strongest modifiable risk factor that was independently associated with treatment defaults. Interventions that target retreated TB cases could also reduce treatment defaults among urban migrants. Health departments should develop effective measures to prevent treatment defaults among urban migrants, to ensure completion of therapy among urban migrants who move between cities and provinces, and to improve reporting of treatment outcomes.

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