International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hilleroed, Denmark.
Int J Epidemiol. 2020 Jun 1;49(3):776-785. doi: 10.1093/ije/dyaa063.
The majority of tuberculosis (TB) cases in low-incidence countries occur in migrants. Only few studies have assessed the long-term TB risk in migrants after immigration, and datasets have not considered this across a range of diverse migrant groups. This nationwide study aimed to investigate long-term TB risk among migrants according to migrant status and region of origin.
This cohort study included all migrants aged ≥ 18 years who obtained residence in Denmark from 1993 to 2015, with a mean follow-up of 10.8 years [standard deviation (SD) 7.3]. Migrants were categorized based on legal status of residence and region of origin. Incidence rates (IR) and rate ratios (IRR) were estimated by Poisson regression.
A total of 142 314 migrants were included. Across all migrants, the TB risk was highest during year 1 of residence (IR 275/100 000 person-years; 95% CI 249-305) followed by a gradual decline, though TB risk remained high for over a decade. Compared with the Danish-born population, the IRRs after 7-8 years were particularly higher among former asylum seekers (IRR 31; 95% CI 20-46), quota refugees (IRR 31; 95% CI 16-71), and family-reunified with refugees (IRR 22; 95% CI 12-44). Sub-Saharan African migrants also experienced elevated risk (IRR 75; 95% CI 51-109). The proportion of migrants with pulmonary TB was 52.4%.
All migrant groups experienced an initial high TB risk, but long-term risk remained high in key migrant groups. Most European countries focus TB screening on or soon after arrival. Our study suggests that approaches to TB screening should be adapted, with migrant populations benefiting from long-term access to preventive health services.
低发病国家的大多数结核病 (TB) 病例发生在移民中。只有少数研究评估了移民后的长期 TB 风险，并且数据集没有考虑到不同移民群体的这一点。本全国性研究旨在根据移民身份和原籍国评估移民的长期 TB 风险。
这项队列研究包括所有在 1993 年至 2015 年间获得丹麦居留权的年龄≥18 岁的移民，平均随访 10.8 年[标准差 (SD) 7.3]。移民根据居住的合法身份和原籍国进行分类。通过泊松回归估计发病率 (IR) 和率比 (IRR)。
共纳入 142314 名移民。在所有移民中，居留的第一年 TB 风险最高（IR 275/100000 人年；95%CI 249-305），随后逐渐下降，但 TB 风险在超过十年的时间内仍然很高。与丹麦出生人口相比，在前难民 (IRR 31；95%CI 20-46)、配额难民 (IRR 31；95%CI 16-71) 和与难民团聚的家庭 (IRR 22；95%CI 12-44) 中，7-8 年后的 IRR 尤其较高。撒哈拉以南非洲移民也经历了较高的风险（IRR 75；95%CI 51-109）。肺结核患者中移民的比例为 52.4%。
所有移民群体最初都经历了高结核病风险，但关键移民群体的长期风险仍然很高。大多数欧洲国家都将结核病筛查重点放在或刚抵达时进行。我们的研究表明，应该调整结核病筛查方法，使移民群体受益于长期获得预防保健服务。
