Objectives. We explored living and working conditions, health status, and health-care access in Chinese rural-to-urban migrants and compared them with permanent rural and urban residents. Methods. A questionnaire was administered to 1,958 urban workers, 1,909 rural workers, and 4,452 migrant workers in Zhejiang Province, Eastern China, in 2004. Blood samples for human immunodeficiency virus (HIV) and syphilis were taken from the migrant and urban workers. Results. Migrants were young, worked very long hours, and their living conditions were very basic. Nineteen percent had some form of health insurance and 26% were entitled to limited sick pay compared with 68% and 66%, respectively, for urban workers. Migrants had the best self-rated health and reported the least acute illness, chronic disease, and disability, after controlling for age and education. There were no HIV infections detected in either the migrant or urban workers. However, 15 urban workers (0.68%, 95% confidence interval [CI] 0.35, 1.02) and 20 migrants (0.48%, 95% CI 0.26, 0.66, p=0.06) tested positive for syphilis. The high cost of health care in the city was a barrier to health-care access in the last year for 15% of the migrants and 8% of the urban workers. Forty-seven percent of the migrants were unwilling to make contributions to health insurance. Conclusions. These migrants demonstrated the "healthy migrant effect." However, poor living conditions and inattention to health may make migrants vulnerable to poor long-term health. Because health insurance schemes will remain limited for the forseeable future, attention should focus on providing affordable health care to both uninsured migrants and the urban poor. ©2008 Association of Schools of Public Health.

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blood sampling urban population China rural area educational status HIV Infections Human immunodeficiency virus infection insurance demography health insurance human epidemiology Insurance Coverage middle aged health service controlled study priority journal health status acute disease Health Surveys Healthy Worker Effect chronic disease Insurance, Health medical leave Health Services Needs and Demand Residence Characteristics Cross-Sectional Studies health care cost migrant worker cross-sectional study Humans human tissue male female questionnaire Syphilis prevalence Article working time major clinical study adult migration health care access disability Transients and Migrants Health Services Accessibility health care delivery health survey