title: Efforts to reduce the disparity between permanent residents and temporary migrants: Stop TB experiences in Shanghai, China.
abstract: OBJECTIVE
  Eight of 17 districts of Shanghai have offered transportation and living allowances subsidies to patients with tuberculosis (TB) among the migrant population. The study aimed to assess the impact of the subsidising initiative on the treatment success rate (TSR) and identify the social determinants of treatment outcomes.
  
  
  METHODS
  The participants included 7072 residents and 5703 migrants who were registered in the TB Information Management System with smear-positive pulmonary TB from January 2006 to December 2010. The Cochran-Armitage test was employed to test the trends of TSR and logistic regressions to identify the factors associated with treatment outcome.
  
  
  RESULTS
  Without subsidies, migrant TB cases had lower odds of successful treatment [OR = 0.20 (95% CI 0.18-0.23)] than resident cases. Subsidisation was associated with a 65% increased odds ratio of success [1.65 (1.40-1.95)] among migrant cases. The TSR has stabilised at 87% for both permanent residents and temporary migrants since 2009. Living in districts with a population density ≥20,000/km(2) was associated with a low odds ratio [0.42 (0.26-0.68)] among resident cases, whereas among migrant cases those living in districts out of central downtown had a higher odds ratio of treatment success [peripheral downtown: 1.73 (1.36-2.20), suburban: 1.69 (1.16-2.46)]. The TB cases in districts with 2.0-2.9 TB specialists/100 cases had a higher odds ratio [2.99 (1.91-4.69)] of successful treatment than cases from districts with fewer specialists.
  
  
  CONCLUSIONS
  Besides free medical services, transport and living allowance subsidies to migrant patients with TB improved the treatment outcome significantly.
authors.affiliation: Department of Social Medicine, School of Public Health, Key Laboratory of Health Technology Assessment (Ministry of Health), Fudan University, Shanghai, China.|Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Lu
authors.affiliation: Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Social Medicine, School of Public Health, Key Laboratory of Health Technology Assessment (Ministry of Health), Fudan University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Social Medicine, School of Public Health, Key Laboratory of Health Technology Assessment (Ministry of Health), Fudan University, Shanghai, China.
authors.forename: Laiwa
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Zhengan
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: Department of Social Medicine, School of Public Health, Key Laboratory of Health Technology Assessment (Ministry of Health), Fudan University, Shanghai, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Yan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D004641:Emigration and Immigration; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011632:Public Assistance; D012923:Social Class; D014171:Transients and Migrants; D014186:Transportation / Q000191:economics; D016896:Treatment Outcome; D014376:Tuberculosis / Q000191:economics / Q000628:therapy; D014397:Tuberculosis, Pulmonary / Q000191:economics / Q000628:therapy*; D055815:Young Adult
keywords: apoyo económico; economic support; equidad; equity; pulmonary tuberculosis; succès du traitement; support économique; treatment success; tuberculose pulmonaire; tuberculosis pulmonar; équité; éxito del tratamiento