S27 Have recent changes to health policies increased diagnostic delay amongst migrant patients with active tb?
S27 Have recent changes to health policies increased diagnostic delay amongst migrant patients with active tb?
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S27 最近卫生政策的变化是否增加了流动结核病患者的诊断延迟？
DOI：
10.1136/thoraxjnl-2017-210983.33
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Potter J
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文献类型：
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作者：
Potter J
背景2014年4月，英国政府启动了“移民和游客费用回收计划”(MVCRP)：这是一系列政策变化，旨在从“可收费”(主要是非英国出生的)患者那里收回费用。在英国，大约75%的结核病病例发生在出生在国外的人身上。延误治疗会增加发病和死亡的风险，并威胁公共健康。我们考虑了自引入MVCRP.方法以来，从出现症状到开始治疗结核病的时间是否有所增加。我们确定了2011至2016年间跨Barts Health NHS Trust在伦敦结核病登记册上通报的成人结核病病例。不完整的数据集被排除。我们使用学生配对t检验检查了政策改变前后在英国出生和非英国出生的患者之间的治疗时间。为了进一步评估非英国出生的患者，我们将所有患者的延迟诊断标记为≥中位 治疗时间(79天)。我们使用卡方检验来寻找相关性，然后建立Logistic回归模型，对年龄、性别、职业、在英国的时间和社会风险因素进行调整。如果其他潜在混杂因素对原始关联没有影响，则不包括在最终模型中。使用Stata15进行分析。结果确定了2237个病例(汇总统计见表1)。在英国出生和非英国出生的人之间，平均治疗时间没有差异(p=0.559)，但在mvcrp后，非英国出生的人的平均治疗时间没有显著增加(p=0.076)。仅在非英国出生的患者中，在引入MVCRP后治疗时间增加(p=0.0008)，他们更有可能延迟诊断(p<；0.001)。调整混杂因素的Logistic回归模型发现，非英国出生的人在引入MVCRP后延迟诊断的可能性增加了37%(AOR1.37，95% CI 1.13~1.66，p=0.001)。我们不能排除未知混杂因素的可能性。然而，迫切需要对限制移民获得医疗保健的政策的影响进行进一步调查。
BackgroundIn April 2014 the UK government launched the ‘Migrant and Visitor Cost Recovery Programme’ (MVCRP): a series of policy changes to recoup costs from ‘chargeable’ (largely non-UK born) patients. In England approximately 75% of tuberculosis (TB) cases occur in those born abroad. Delays in treatment increase the risk of morbidity and mortality and threaten public health. We considered whether time between symptom onset and starting treatment for TB has increased since the introduction of the MVCRP.MethodsAdult TB cases notified on the London TB Register across Barts Health NHS Trust between 2011 and 2016 were identified. Incomplete data sets were excluded. We examined time to treatment between UK born and Non-UK born patients before and after the policy change using a student paired t-test. To further evaluate non-UK born patients, we labelled a delayed diagnosis as ≥median time to treatment for all patients (79 days). We used a chi-squared test to look for an association before developing a logistic regression model adjusting for age, sex, occupation, time in the UK and social risk factors. Other potential confounders were not included in the final model if they had no effect on the original association. Analyses were performed using Stata15.Results2237 cases were identified (for summary statistics see Table 1). Pre-MVCRP there was no difference in the mean time to treatment between the UK born and non-UK born (p=0.559) but post MVCRP there was a non-significant increase for the non-UK born (p=0.076). Amongst non-UK born patients only, time to treatment increased following introduction of MVCRP (p=0.0008) and they were more likely to have a delayed diagnosis (p<0.001). A logistic regression model adjusting for confounders found that the non-UK born were 37% more likely to have a delay in diagnosis post introduction of the MVCRP (aOR 1.37, 95% CI 1.13–1.66, p=0.001).ConclusionOur findings suggest an association between the introduction of the MVCRP and risk of a delayed TB diagnosis amongst migrants. We cannot exclude the possibility of unknown confounders. However, further investigation into the effect of policies restricting access to healthcare for migrants is urgently needed.