A population-based study of tuberculosis epidemiology and innovative service delivery in Canada
Abstract:OBJECTIVE: To compare and interpret tuberculosis (TB) incidence rates in a Canadian population across two decennials (1989–1998 and 1999–2008) as a benchmark for World Health Organization targets and the long-term goal of TB elimination. The population under study was served by two urban clinics in the first decennial and two urban and one provincial clinic in the second.
METHODS: TB rates among Status Indians, Canadian-born ‘others’ and the foreign-born were estimated using provincial and national databases. Program performance was measured in on-reserve Status Indians in each decennial.
RESULTS: In each decennial, the incidence rate in Status Indians and the foreign-born was greater than that in the Canadian-born ‘others’; respectively 27.7 and 33.0 times in Status Indians, and 8.0 and 20.9 times in the foreign-born. Between decennials, the rate fell by 56% in Status Indians, 58% in Canadian-born ‘others’, and 18% in the foreign-born. On-reserve Status Indians had higher rates than off-reserve Status Indians, and the three-clinic model out-performed the two-clinic model among those on-reserve. Rates in the foreign-born varied by World Bank region, and were highest among those from Africa and Asia.
CONCLUSION: Status Indians and the foreign-born are at increased risk of TB in Canada. Significant progress towards TB elimination has been made in Status Indians but not in the foreign-born.
Document Type: Research Article
Affiliations: 1: Tuberculosis Program Evaluation and Research Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada 2: Tuberculosis Program Evaluation and Research Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada 3: Tuberculosis Program Evaluation and Research Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada; and Provincial Program Development and Disease Control Branch, Alberta Health and Wellness, Edmonton, Alberta, Canada
Publication date: January 1, 2012
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