Factors associated with exposure to tuberculosis education among internal migrants with diabetes in China: A multilevel regression analysis of cross-sectional data from the 2017 China Migrants Dynamic Survey

Abstract

Objective Individuals with diabetes are at high risk for tuberculosis (TB) infection. This study aimed to identify the barriers to access to TB education among internal migrants with diabetes in China. Design Cross-sectional study. Setting The 2017 China Migrants Dynamic Survey. Participants 1978 migrants with diabetes were included. Consumer-side and provider-side factors both at the individual and the provincial level were considered. Outcome measures Two-level and multivariate logistic regression models were established to identify the factors associated with exposure to TB education among migrants with diabetes over the past year at their migration destination. Results Slightly more than one-third (33.52%) of the study participants received TB education. Individuals residing in provinces with higher TB death rates (adjusted OR (AOR)=1.48, 95% CI 1.02 to 2.15) and higher government spending as a proportion of total health expenditure (AOR=2.06, 95% CI 1.41 to 3.02) were more likely to be exposed to TB education. Higher individual awareness of essential public health services (AOR=3.52, 95% CI 2.69 to 4.59), establishment of personal health records at the migration destination (AOR=1.46, 95% CI 1.12 to 1.90), participation in community monitoring of hypertension/diabetes (AOR=1.95, 95% CI 1.52 to 2.51) and other factors were significant predictors of exposure to TB education (p<0.05). Participants older than 60 years were 27% less likely to receive TB education (AOR=0.73, 95% CI 0.54 to 0.99) compared with others. Conclusion The coverage of TB education among internal migrants with diabetes in China was lower than in some local communities, particularly among those who were older and had migrated long distances. Improving awareness of and access to basic public health services and social inclusion are critical to improving TB education.