Population-based risk factors for tuberculosis and adverse outcomes among Tibetan refugees in India, 1994 –1996
OBJECTIVE: To determine tuberculosis (TB) incidence, independent risk factors for TB, and predictors of adverse outcomes.
DESIGN: Data from a house-to-house census/demographic survey were merged with TB patient data. Separate multivariable models for each birthplace were developed for outcomes of interest.
RESULTS: From 1994 to 1996, 47491 Tibetans were surveyed and 1197 TB cases confirmed (incidence 835/100000). Risk factors for TB in separate multivariable models differed by place of birth. Independent predictors of death for Tibet-born refugees included age ≥50 years, extra-pulmonary TB, and second-line therapy, while for India-born refugees they included second-line therapy and no improvement at the end of treatment. No significant risk factors for default were identified for Tibet-born refugees, while region of residence and the absence of a BCG scar were independent predictors among those born in India. Predictors of receipt of second-line therapy among Tibet-born refugees included region, years in camps, and prior TB, while among those born in India they were region, age ≥20 years, sputum-positive at diagnosis, and previous TB.
CONCLUSIONS: TB incidence in Tibetan refugee settlements exceeds the highest national TB rates, and country of birth determines risk factors. TB control efforts in India should include this population.
Document Type: Regular Paper
Affiliations: 1: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Data Unit, Health Department, Tibetan Government in Exile, Dharamsala, Himachal Pradesh, India 3: Tuberculosis Unit, Health Department, Tibetan Government in Exile, Dharamsala, Himachal Pradesh, India
Publication date: 2005-09-01
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