Cancer diagnosis and care among rural-to-urban migrants in China

Rebecca Myerson; Tianyi Lu; Yong Yuan; Gordon Guo-En Liu

doi:10.1136/bmjgh-2019-001923

Cancer diagnosis and care among rural-to-urban migrants in China

BMJ Glob Health. 2019 Dec 18;4(6):e001923. doi: 10.1136/bmjgh-2019-001923. eCollection 2019.

Authors

Rebecca Myerson¹, Tianyi Lu², Yong Yuan³, Gordon Guo-En Liu⁴

Affiliations

¹ Population Health Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA.
² Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, California, USA.
³ Global Health Economics and Outcomes Research, Bristol-Myers Squibb Co, New York City, New York, USA.
⁴ Peking University National School of Development, Beijing, China.

Abstract

Introduction: Cancer is a leading cause of death in China. Rural-to-urban migrants are a group of over 260 million people in China sometimes termed the 'floating' population. This study assessed the prevalence of cancer diagnosis and access to needed healthcare by residence and migration status in China.

Methods: We used data from the China Health and Retirement Longitudinal Survey, a nationally representative population-based random sample of adults age 45 years and older and their spouses in China. We used multivariable logistic regressions to compare outcomes among rural-to-urban migrants, local urban residents and local rural residents after adjusting for province of residence, socioeconomic status and demographic characteristics.

Results: The sample included 7335 urban residents, 9286 rural residents and 3255 rural-to-urban migrants. Prevalence of cancer diagnosis was 9.9 per 1000 population among rural-to-urban migrants (95% CI 6.5 to 15.1 per 1000 population). Rural-to-urban migrants had higher tobacco use (OR=2.01; 95% CI 1.59 to 2.56, p<0.001), lower use of a health check-up (OR=0.57; 95% CI 0.48 to 0.67, p<0.001) and lower prevalence of diagnosed cancer (OR=0.41; 95% CI 0.18 to 0.95, p=0.037) than urban residents. Among participants with diagnosed cancer, residence and migration status were not predictive of foregoing needed healthcare, but were predictive of diagnosis with a screen-detectable tumour (ie, breast, colon, prostate or cervical cancer) (OR=0.17; 95% CI 0.05 to 0.63, p=0.007 for rural residents; OR=0.34; 95% CI 0.09 to 1.22, p=0.098 for rural-to-urban migrants, compared with urban residents).

Conclusion: Rapid and large migration is still a driving force transitioning China. Due to some remaining dual policy settings in favour of local residents, rural migrants tend to use lower primary care and preventive health check-ups in general, and diagnosis of screen-detectable tumours in particular, leading to potentially higher risk of missing early diagnosis of cancers. Closing gaps in diagnosis of screen-detectable tumours could increase treatment and improve cancer outcomes.

Keywords: cancer; cross-sectional survey; descriptive study; diagnostics and tools; public health.