This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wobeser, W. L.
Right arrow Articles by Holness, D. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wobeser, W. L.
Right arrow Articles by Holness, D. L.
Related Collections
Right arrow Socioeconomic determinants of health
Right arrow Health education
Right arrow Tuberculosis
CMAJ • October 3, 2000; 163 (7)
© 2000 Canadian Medical Association or its licensors

Research
Recherche

Expanding the epidemiologic profile: risk factors for active tuberculosis in people immigrating to Ontario

Wendy L. Wobeser*, Lilian Yuan{dagger}, Monika Naus{ddagger}, Paul Corey{dagger}, Jeff Edelson§, Neil Heywood and D. Linn Holness{dagger}

From *the Department of Medicine, Queen's University, Kingston, Ont.; {dagger}the Department of Public Health Sciences, University of Toronto, Toronto, Ont.; {ddagger}the Public Health Branch, Ministry of Health, Toronto, Ont.; §SmithKline Beecham Pharmaceuticals, Collegeville, Pa.; and ¶Selection Branch, Citizenship and Immigration Canada, Ottawa, Ont.

Background: Many people immigrating to Canada come from countries with a high burden of tuberculosis. The aim of this study was to develop a detailed epidemiologic profile of foreign-born people with tuberculosis living in Ontario.

Methods: In this population-based case-control study, cases of tuberculosis diagnosed in 1994-1995 were identified from the database of the Ontario Reportable Disease Information Service and were considered eligible for analysis if a record of landing (receipt of permission to establish residence in Canada) from the period 1986-1995 was found in the Citizenship and Immigration Canada (CIC) database, if the person was at least 11 years of age at the time their visa was issued, and if the person had not been diagnosed with tuberculosis before becoming legally landed in Canada. Control subjects, who met the same criteria as the case subjects but who did not have tuberculosis in 1994-1995, were identified from a CIC database for landed immigrants.

Results: A total of 1341 cases of tuberculosis in foreign-born people were reported in Ontario in 1994-1995. A record of landing was found in CIC databases for 1099 of these people, 224 of whom were not legally landed at the time of diagnosis. In total, 602 cases met the inclusion criteria. The 2 strongest determinants of risk among those who had become landed within the preceding 10 years were referral for medical surveillance by immigration officials (odds ratio [OR] 3.8, 95% confidence interval [CI] 2.6-6.0) and world region of origin (Somalia [OR 67.7, 95% CI 31.3-154.9], Vietnam [OR 25.0, 95% CI 12.5-50.0], the Philippines [OR 11.9, 95% CI 6.0-23.3], other sub-Saharan African countries [OR 11.6, 95% CI 5.7-23.2], India [OR 9.7, 95% CI 4.9-18.9], China [OR 6.1, 95% CI 3.1-12.1], other Asian countries [OR 4.7, 95% CI 2.4-9.1], the Middle East [OR 4.1, 95% CI 2.0-8.3], Latin America [OR 1.9, 95% CI 0.9-3.8), and the former socialist countries of Europe [OR 1.8, 95% CI 0.8-3.8]; the reference category was countries with established market economies). Low socioeconomic status was an independent risk factor.

Interpretation: The risk of tuberculosis in groups of people migrating to Ontario is highly variable and is influenced by several factors. Successful population-based tuberculosis prevention strategies will need to accommodate this variabilit




This article has been cited by other articles:


Home page
 J. Clin. Microbiol.Home page
D. C. Alexander, J. L. Guthrie, D. Pyskir, A. Maki, N. Kurepina, B. N. Kreiswirth, P. Chedore, S. J. Drews, and F. Jamieson
Mycobacterium tuberculosis in Ontario, Canada: Insights from IS6110 Restriction Fragment Length Polymorphism and Mycobacterial Interspersed Repetitive-Unit-Variable-Number Tandem-Repeat Genotyping
J. Clin. Microbiol., August 1, 2009; 47(8): 2651 - 2654.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
U. R. Dahle, V. Eldholm, B. A. Winje, T. Mannsaker, and E. Heldal
Impact of Immigration on the Molecular Epidemiology of Mycobacterium tuberculosis in a Low-Incidence Country
Am. J. Respir. Crit. Care Med., November 1, 2007; 176(9): 930 - 935.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
D. Menzies
Screening immigrants to Canada for tuberculosis: Chest radiography or tuberculin skin testing?
Can. Med. Assoc. J., November 11, 2003; 169(10): 1035 - 1036.
[Full Text]

Home page
 CMAJHome page
N. Heywood, B. Kawa, R. Long, H. Njoo, L. Panaro, and W. Wobeser
Guidelines for the investigation and follow-up of individuals under medical surveillance for tuberculosis after arriving in Canada: a summary
Can. Med. Assoc. J., June 10, 2003; 168(12): 1563 - 1565.
[Full Text] [PDF]

Home page
 Int J EpidemiolHome page
B. Smith, M. A K Ryan, G. C Gray, J. M Polonsky, and D. H Trump
Tuberculosis infection among young adults enlisting in the United States Navy
Int. J. Epidemiol., October 1, 2002; 31(5): 934 - 939.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
M. B. Murray
Molecular epidemiology and the dynamics of tuberculosis transmission among foreign-born people
Can. Med. Assoc. J., August 1, 2002; 167(4): 355 - 356.
[Full Text] [PDF]