{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T00:07:06Z","timestamp":1793578026162,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2024,10,26]],"date-time":"2024-10-26T00:00:00Z","timestamp":1729900800000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,9,30]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to examine patient delay, diagnosis delay and treatment performance among patients with tuberculosis (TB) in Shanghai, China in 2018\u20132020 focusing on disparities between migrant and local patients with TB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Mixed-method study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>Quantitative data were collected from the TB information management system in Shanghai; 17\u2009533 bacteriologically confirmed and clinically diagnosed patients with pulmonary TB registered in 2018\u20132020 were included. Qualitative interviews were conducted with TB administrators (n=3) and community healthcare providers (two groups, n=10 in total) from Shanghai.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Patient delay, diagnosis delay and treatment completion were examined by resident type using descriptive analysis and logistic regressions. Qualitative interviews were conducted to understand factors associated with the disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2018 to 2020, migrant patients with TB accounted for 44.40% of total cases. There was no significant difference in patient delay between migrant and local patients (18.47\u2009days on average). 22.12% of migrants and 16.52% of locals experienced diagnosis delays exceeding 14 days, respectively. After adjusting for all variables, migrant patients (OR 1.30, 95% CI 1.18 to 1.44) and initial care seeking at general hospitals (OR 3.76, 95% CI 3.45 to 4.09) were associated with a higher probability of diagnosis delay. 93.9% of migrant patients and 89.4% of the local patients had a successful TB treatment without statistically significant difference after adjusting for all variables. Qualitative interviews revealed a standard approach to managing patients with TB in Shanghai no matter their resident type. Young migrant patients who were able to maintain their jobs in Shanghai often had better treatment adherence. Despite patients\u2019 COVID-19 fear and limited care access in 2020, TB treatment minimally affected for both due to community-based case management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Migrant patients were more likely to experience diagnosis delay. It should improve awareness and knowledge of TB among healthcare professionals at general hospitals to mitigate the risk of diagnosis delay.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-082430","type":"journal-article","created":{"date-parts":[[2024,10,26]],"date-time":"2024-10-26T07:55:53Z","timestamp":1729929353000},"page":"e082430","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Patient delay, diagnosis delay, and treatment outcomes among migrant patients with tuberculosis in Shanghai, China, 2018-2020: a mixed-methods study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5456-2525","authenticated-orcid":false,"given":"Yufei","family":"Jia","sequence":"first","affiliation":[{"name":"Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixi","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Xiao","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhexun","family":"Lou","sequence":"additional","affiliation":[{"name":"Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenglan","family":"Tang","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Chen","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1444-6815","authenticated-orcid":false,"given":"Qian","family":"Long","sequence":"additional","affiliation":[{"name":"Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China"},{"name":"Duke Global Health Institute, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,10,26]]},"reference":[{"key":"2025121222530545000_14.10.e082430.1","unstructured":"WHO . 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