Local epidemic history as a predictor of tuberculosis incidence in Saskatchewan Aboriginal communities
Abstract:BACKGROUND: Average tuberculosis (TB) incidence rates are high in Canadian Aboriginal communities, but there is significant variability within this group.
OBJECTIVE: To determine whether local history of post-contact TB epidemics is predictive of contemporary epidemiology among Aboriginal communities in Saskatchewan, Canada.
METHODS: TB incidence, age-specific morbidity patterns and rates of clustering of TB genotypes from 1986 to 2004 were compared between two groups of communities: Group 1, in which post-contact epidemics of TB were established around 1870, and Group 2, in which they were delayed until after 1920. Concomitant effects of socio-economic and geographic variables were explored with multivariate models.
RESULTS: Group 2 communities were characterized by higher annual incidence of TB (median 431 per 100 000 population vs. 38/100 000). In multivariate models that included socio-economic and geographic variables, historical grouping remained a significant independent predictor of community incidence of TB. Clustering of TB genotypes was associated with Group 2 (OR 8.7, 95%CI 3.3–22.7) and age 10–34 years (OR 2.5, 95%CI 1.1–5.7).
CONCLUSIONS: TB transmission dynamics can vary significantly as a function of a population's historical experience with TB. Populations at different stages along the epidemic trajectory may be amenable to different types of interventions.
Document Type: Regular Paper
Affiliations: 1: Division of Infectious Diseases, School of Medicine, Stanford University, Stanford, California, USA 2: Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada 3: Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Publication date: July 1, 2011
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