Patterns of tuberculosis risk over time among recent immigrants to Ontario, Canada
Abstract:SETTING: Canada receives more than 200000 immigrants annually. Immigrants account for 92% of tuberculosis (TB) cases in Toronto, Ontario. Epidemiological profiling of recent immigrants is needed to provide more effective TB programs.
DESIGN: A population-based, retrospective cohort study of recent immigrants to Ontario, 1990–1997. We generated adjusted rates, risk ratios (RRs), hazard rates since arrival, and a complementary log-log model to describe TB risk, compare the survival distributions between different sexes, age groups and world regions of birth, and determine predictors of disease.
RESULTS: TB in recent immigrants was 23 times (95%CI 20.9–25.5) higher than in Canadian-born, non-aboriginal people. Those aged 16–30 and >65 years experienced the highest rates. Sub-Saharan Africa had the highest rates for both sexes (RR 95.5, 95%CI 84.3–108.2), followed by India and Asia. Hazard rates decreased after arrival, but remained elevated. The highest risk was associated with arrival in 1990 and living in Canada <1 year.
CONCLUSION: Risk for TB varied by region of birth, age at landing and time since arrival. Sex was not significant. Persons from sub-Saharan Africa and age >65 years were the highest risk groups. Risk decreased significantly in the first 1–2 years after arrival, after which it plateaued.
Document Type: Regular Paper
Affiliations: 1: Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada 2: Department of Community Health & Epidemiology, Queen's University, Kingston, Canada 3: Department of Community Health & Epidemiology, Queen's University, Kingston, Canada; and Department of Medicine, Queen's University, Kingston, Canada
Publication date: 2005-06-01
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