Epidemiological Characteristics Of Infectious Diseases And Health Service Utilization For Foreign Population In China

Background and ObjectivePopulation movements promoted exchanges between countries and also lead to the spread of diseases.With the economic globalization,transportation was becoming more and more convenient,and the number of foreigners coming to China was increasing.The frequent migration of foreigners in China posed certain risks to the spread of infectious diseases,especially severe infectious diseases,and brought certain challenges to the health systems.We aimed to assess the epidemic features of infectious diseases found commonly in foreign population in China between 2004 and 2017,and to explore the differences in epidemic characteristics of infectious diseases between foreigners and Chinese.To understand the epidemiological characteristics of imported dengue fever and malaria for foreign population coming to China,and furtherly identify the driving factors contributed to foreign imported malaria.Also,we sought to understand the status of health service need,supply and utilization for foreigners in China and explore risk factors of health service utilization among foreign population.These data served to strengthen responses for infectious diseases,and formulate public health policy for foreigners in China.MethodsWe performed a descriptive study of notifiable infectious diseases among foreigners reported from 2004 to 2017 in China using data from the Chinese National Notifiable Infectious Disease Reporting System.Temporal trends and seasonal characteristics were analyzed by Joinpoint regression and seasonal index,respectively.The epidemiological characteristics of major infectious diseases between Chinese and foreign nationalities was compared to explore possible mutual transmission.The epidemiological characteristics of imported dengue fever and malaria for foreign population in China were also analyzed.Modularity analysis was used to analyze the relationship between the source countries and destination provinces.Poisson regression model was used to explore the influencing factors of imported malaria in foreign population.We conducted a questionnaire investigation and qualitative interviews to understand the health service need,supply and utilization for foreign residents among Yiwu in Zhejiang and Yuexiu in Guangdong,and explore risk factors of health service utilization using logistic regression.ResultsA total of 62,475 cases of 33 different infectious diseases were reported among foreigners,with an incidence rate of 17.94 per 100,000.There was an increasing trend,with an average annual percentage change of 4.2.These diseases were seen in 31 provinces of China and originated from 146 countries of the world.Yunnan province had the highest number of notifiable infectious diseases in foreigners,followed by Beijing and Guangdong.The incidence of infectious diseases among foreign females and children under 15 years old was relatively high,and increased very fast.The infectious diseases with the highest incidence number were human immunodeficiency virus of 15,319 cases,hand,foot,and mouth disease(6,367 cases)and other infectious diarrheas(5,629 cases).HIV/AIDS,hand,foot and mouth disease,syphilis,influenza and dengue fever were on the rise.The incidence of hepatitis B,C,malaria and dysentery were on the decline.For other infectious diarrhea diseases and tuberculosis,the incidence remained stable,while gonorrhea tended to increase first and then decreased.56.13%of HIV/AIDS,83.14%of dengue fever,75.75%of malaria,53.66%of tuberculosis,32.89%of hepatitis C and 17.36%of hepatitis B are concentrated in Yunnan,mainly from Myanmar.30.07%of hepatitis C and 18.31%of hepatitis B are reported by Inner Mongolia,mainly from Mongolia.Hand,foot and mouth disease and gonorrhea are mainly distributed in Shanghai,dysentery,other infectious diarrhea and influenza are mainly distributed in Beijing,mostly from the United States and Japan.Guangdong reported the most cases of syphilis,mainly from Southeast Asian countries.The epidemiological characteristics of main infectious diseases among foreigners varied from Chinese population,which may be imported or scattered transmission.There were 38 different foreign infectious diseases imported in China between 2005 and 2017.The most reporting imported infectious diseases were dengue fever and malaria.Foreign imported dengue fever and malaria showed an ascending trend.Yunnan province,Myanmar and Laos contained the largest cases of dengue fever and malaria between overseas and China.By comparison,imported dengue fever between Yunnan province and other provinces of China showed different epidemic characteristics.Yunnan presented an obvious upward trend,with a high incidence in October,and women and young cases were dominated.Other provinces of China rose slowly,and most cases were seen from January to December,mainly male and middle-aged.African and Asian population had different epidemic characteristics of imported malaria.The incidence of imported malaria from African population showed a large increase,with a high incidence from August to October,and Plasmodium falciparum malaria accounting for 85.66%,while,Asian population kept stable,concentrated in May-June,and Plasmodium vivax malaria accounting for 64.14%.The number of imported malaria cases for foreign population was significantly associated with the volume of foreigners entering China(?=0.82,P<0.001)and the incidence of malaria among countries ?=0.40,P=0.007).The economic and health status of different countries had no significant impact on foreign imported malaria.At present,there is no specific health policy or management measures for foreign population in China.The health services of foreigners were mostly same with those of Chinese population,but there were some omissions and problems.The health service utilization survey showed that health service needs were common for foreigners among Yiwu in Zhejiang and Yuexiu in Guangdong,with an average rate of 71.73%.However,the utilization of health services was at a low level that 54.22%of foreign patients had visited Chinese medical institutions.The rate of health service utilization for Africans was 47.35%,lower than that of Asians.Living in China for more than ten months(OR=1.48),having medical insurance(OR=1.31),seeing a doctor for fever in time(OR=2.20),knowing medical institutions near the place of residence(OR=6.15)were major promoting factors for foreign cases receiving Chinese health services.Having chronic diseases(OR=0.66)was the factor that hindered foreigners from seeing Chinese doctors.Economic income and Chinese language level had no significant effect on visiting Chinese hospitals for foreign cases,whereas,the high medical expenses and poor language communication during medical consultation process were problems that foreigners commonly reflected.The hospitalization rate of foreigners was 5.45%,lower than the level of Chinese population.The main reason for hospitalization was childbirth,accounting for 50%.Living with others was the main influencing factor for foreigners receiving hospitalization.Foreigners' health knowledge level was insufficient,and the acceptance rate of health education was low.Only 24.69%of foreigners have received health education in China.Foreigners with a medical background(OR=2.25),occupation as a farmer(OR=2.67),government or technical personnel(OR=4.26),having a sick(OR=1.39),were more likely to have received health education.ConclusionThis is the first long-term analysis of the epidemiological and imported characteristic of infectious diseases and the first investigation of the health service utilization and its risk factors of foreigners in some areas in China.Foreign population had unique epidemiological features of infectious diseases different from Chinese population,which were mostly imported or scattered between 2004?2017.Yunnan province had the highest number of notifiable infectious diseases and HIV was the most commonly reported disease in foreigners.There were different trends,seasonal characteristics and geographical distribution of the major infectious diseases among foreign cases seen in China.The imported dengue and malaria epidemic among foreigners continued to rise,and the number of reported provinces had an obvious increase,partly influencing the import and prevalence of infectious diseases in China.The level of health service need for foreigners in China was high,while,health service utilization was not enough.Health status,health awareness and medical insurance were important factors that affected the medical utilization of foreigners.These results can be used to better conduct the management of infectious diseases,prevent and control infectious disease,especially severe infectious diseases,strengthen the early detection and diagnosis of diseases and formulate health policies for foreigners coming to China in the future.