Wobeser W L, Yuan L, Naus M, Corey P, Edelson J, Heywood N, Holness D L
Department of Medicine, Queen's University, Kingston, Ont.
CMAJ. 2000 Oct 3;163(7):823-8.
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.
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.
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.
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 variability.
许多移民到加拿大的人来自结核病负担较重的国家。本研究的目的是详细描述安大略省外国出生的结核病患者的流行病学特征。
在这项基于人群的病例对照研究中，1994 - 1995年诊断出的结核病病例从安大略省法定疾病信息服务数据库中识别出来，如果在加拿大公民及移民部（CIC）数据库中发现1986 - 1995年期间的登陆记录（获得在加拿大定居的许可），且该人在签证签发时至少11岁，并且在合法登陆加拿大之前未被诊断出患有结核病，则被认为符合分析条件。对照对象从CIC的登陆移民数据库中识别，他们符合与病例对象相同的标准，但在1994 - 1995年没有患结核病。
1994 - 1995年安大略省共报告了1341例外国出生的结核病病例。其中1099人在CIC数据库中有登陆记录，其中224人在诊断时未合法登陆。总共有602例符合纳入标准。在之前10年内登陆的人群中，两个最强的风险决定因素是移民官员转介进行医疗监测（比值比[OR] 3.8，95%置信区间[CI] 2.6 - 6.0）和原籍世界地区（索马里[OR 67.7，95% CI 31.3 - 154.9]，越南[OR 25.0，95% CI 12.5 - 50.0]，菲律宾[OR 11.9，95% CI 6.0 - 23.3]，其他撒哈拉以南非洲国家[OR 11.6，95% CI 5.7 - 23.2]，印度[OR 9.7，95% CI 4.9 - 18.9]，中国[OR 6.1，95% CI 3.1 - 12.1]，其他亚洲国家[OR 4.7，95% CI 2.4 - 9.1]，中东[OR 4.1，95% CI 2.0 - 8.3]，拉丁美洲[OR 1.9，95% CI 0.9 - 3.8]，以及欧洲前社会主义国家[OR 1.8，95% CI 0.8 - 3.8]；参考类别为市场经济发达的国家）。低社会经济地位是一个独立的风险因素。
移民到安大略省的人群中结核病风险差异很大，且受多种因素影响。成功的基于人群的结核病预防策略需要适应这种差异。
