Abstract
Non-national migrants have limited access to medical therapy. This study compares diagnostic delay and treatment outcomes of non-insured non-national migrants (NINNM) with insured Israeli citizens (IC) in the Tel Aviv tuberculosis (TB) clinic between 1998 and 2008. Patient delay was the time from symptoms onset to doctor's visit, while system delay was measured from doctor visit to anti-TB therapy administration. We randomly sampled 222 NINNM and 265 IC. NINNM were younger than IC, had lower male to female ratio and fewer smoked. They had less drug/alcohol abuse, more cavitations on chest radiography, longer patient and shorter system delay. Mean patient and system delays of all patients were 25 ± 14 and 79 ± 42 days, respectively. In multivariate analysis, being NINNM, asymptomatic or smoking predicted longer patient delay, while being asymptomatic or having additional co-morbidity predicted longer system delay. Treatment success in sputum smear-positive pulmonary TB NINNM was 81% and 95.7% in IC (p=0.01). Treatment success was not associated with patient or system delay. In multivariate analysis, work security and treatment adherence predicted treatment success. NINNM had longer patient delay and worse therapy outcome, while IC had longer system delay. Both delays should be reduced. NINNM should be informed that TB therapy is free and unlinked with deportation.
Highlights
The global movement of people from less-resourced countries to more affluent and industrialised countries seeking work and improved living conditions has increased during the last decades [1]
non-insured non-national migrants (NINNM) were diagnosed with TB 3.1±2.7 years following their arrival in Israel, and the Israeli citizens (IC) (n=165, 62.5% of all IC) who were born outside Israel were diagnosed 23±17 years after their arrival (p
NINNM were younger than IC, were more often females, were more likely to originate in high TB burden countries, and to be employed while diagnosed
Summary
The global movement of people from less-resourced countries to more affluent and industrialised countries seeking work and improved living conditions has increased during the last decades [1]. Most industrialised countries cover TB treatment costs for all non-national migrants (NNM), mainly to protect the citizens in the hosting countries from infection [6]. This approach is being practiced in Israel, which has become a selected destination for labor migration since the early 1990ies. Unlike NNM, Jewish homecomers to Israel are naturalised upon arrival and are never refused nor delayed, regardless of their health status, age, education or sex They are entitled to a comprehensive package of social, educational and financial benefits, including medical insurance from day one of their arrival, in order to accelerate their absorption into society. The policy of encouraging the migration of individuals of Jewish decent is one of the core values of the Israeli society, who is keen to assimilate the newcomers [8]
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