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Free Content Population-based risk factors for tuberculosis and adverse outcomes among Tibetan refugees in India, 1994 –1996

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SETTING: 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.
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Keywords: India; Tibet; refugees; tuberculosis

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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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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