Domestic impact of tuberculosis screening among new immigrants to Ontario, Canada
All Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration surveillance for the disease. We sought to quantify the domestic health impact of screening for TB in all new immigrants and to identify mechanisms to enhance effe...
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| Vydané v: | Canadian Medical Association journal (CMAJ) Ročník 187; číslo 16; s. E473 - E481 |
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| Hlavní autori: | , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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Canada
Elsevier Inc
03.11.2015
Joule Inc CMA Impact, Inc 8872147 Canada Inc |
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| ISSN: | 0820-3946, 1488-2329 |
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| Abstract | All Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration surveillance for the disease. We sought to quantify the domestic health impact of screening for TB in all new immigrants and to identify mechanisms to enhance effectiveness and efficiency of this screening.
We linked preimmigration medical examination records from 944 375 immigrants who settled in Ontario between 2002 and 2011 to active TB reporting data in Ontario between 2002 and 2011. Using a retrospective cohort study design, we measured birth country–specific rates of active TB detected through preimmigration screening and postimmigration surveillance. We then quantified the proportion of active TB cases among residents of Ontario born abroad that were detected through postimmigration surveillance. Using Cox regression, we identified independent predictors of active TB postimmigration.
Immigrants from 6 countries accounted for 87.3% of active TB cases detected through preimmigration screening, and 10 countries accounted for 80.4% of cases detected through postimmigration surveillance. Immigrants from countries with a TB (all-sites) incidence rate of less than 30 cases per 100 000 persons resulted in pre- and postimmigration detection of 2.4 and 0.9 cases per 100 000 immigrants, respectively. Postimmigration surveillance detected 2.6% of active TB cases in Ontario residents born abroad, and TB was detected a median of 18 days earlier in those undergoing surveillance than in those who were not referred to surveillance or who did not comply. Predictors of active TB postimmigration included radiographic markers of old TB, birth country, immigration category, location of application for residency, immune status and age.
Universal screening for TB in new immigrants has a modest impact on the domestic burden of active TB and is highly inefficient. Focusing preimmigration screening in countries with high incidence rates and revising criteria for postimmigration surveillance could increase the effectiveness and efficiency of screening. |
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| AbstractList | Background: All Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration surveillance for the disease. We sought to quantify the domestic health impact of screening for TB in all new immigrants and to identify mechanisms to enhance effectiveness and efficiency of this screening. Methods: We linked preimmigration medical examination records from 944 375 immigrants who settled in Ontario between 2002 and 2011 to active TB reporting data in Ontario between 2002 and 2011. Using a retrospective cohort study design, we measured birth country-specific rates of active TB detected through preimmigration screening and postimmigration surveillance. We then quantified the proportion of active TB cases among residents of Ontario born abroad that were detected through postimmigration surveillance. Using Cox regression, we identified independent predictors of active TB postimmigration. Results: Immigrants from 6 countries accounted for 87.3% of active TB cases detected through preimmigration screening, and 10 countries accounted for 80.4% of cases detected through postimmigration surveillance. Immigrants from countries with a TB (all-sites) incidence rate of less than 30 cases per 100 000 persons resulted in pre- and postimmigration detection of 2.4 and 0.9 cases per 100 000 immigrants, respectively. Postimmigration surveillance detected 2.6% of active TB cases in Ontario residents born abroad, and TB was detected a median of 18 days earlier in those undergoing surveillance than in those who were not referred to surveillance or who did not comply. Predictors of active TB postimmigration included radiographic markers of old TB, birth country, immigration category, location of application for residency, immune status and age. Interpretation: Universal screening for TB in new immigrants has a modest impact on the domestic burden of active TB and is highly inefficient. Focusing preimmigration screening in countries with high incidence rates and revising criteria for postimmigration surveillance could increase the effectiveness and efficiency of screening. All Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration surveillance for the disease. We sought to quantify the domestic health impact of screening for TB in all new immigrants and to identify mechanisms to enhance effectiveness and efficiency of this screening. We linked preimmigration medical examination records from 944,375 immigrants who settled in Ontario between 2002 and 2011 to active TB reporting data in Ontario between 2002 and 2011. Using a retrospective cohort study design, we measured birth country-specific rates of active TB detected through preimmigration screening and postimmigration surveillance. We then quantified the proportion of active TB cases among residents of Ontario born abroad that were detected through postimmigration surveillance. Using Cox regression, we identified independent predictors of active TB postimmigration. Immigrants from 6 countries accounted for 87.3% of active TB cases detected through preimmigration screening, and 10 countries accounted for 80.4% of cases detected through postimmigration surveillance. Immigrants from countries with a TB (all-sites) incidence rate of less than 30 cases per 100 000 persons resulted in pre- and postimmigration detection of 2.4 and 0.9 cases per 100 000 immigrants, respectively. Postimmigration surveillance detected 2.6% of active TB cases in Ontario residents born abroad, and TB was detected a median of 18 days earlier in those undergoing surveillance than in those who were not referred to surveillance or who did not comply. Predictors of active TB postimmigration included radiographic markers of old TB, birth country, immigration category, location of application for residency, immune status and age. Universal screening for TB in new immigrants has a modest impact on the domestic burden of active TB and is highly inefficient. Focusing preimmigration screening in countries with high incidence rates and revising criteria for postimmigration surveillance could increase the effectiveness and efficiency of screening. Interpretation: Universal screening for TB in new immigrants has a modest impact on the domestic burden of active TB and is highly inefficient. Focusing preimmigration screening in countries with high incidence rates and revising criteria for postimmigration surveillance could increase the effectiveness and efficiency of screening. BACKGROUNDAll Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration surveillance for the disease. We sought to quantify the domestic health impact of screening for TB in all new immigrants and to identify mechanisms to enhance effectiveness and efficiency of this screening.METHODSWe linked preimmigration medical examination records from 944,375 immigrants who settled in Ontario between 2002 and 2011 to active TB reporting data in Ontario between 2002 and 2011. Using a retrospective cohort study design, we measured birth country-specific rates of active TB detected through preimmigration screening and postimmigration surveillance. We then quantified the proportion of active TB cases among residents of Ontario born abroad that were detected through postimmigration surveillance. Using Cox regression, we identified independent predictors of active TB postimmigration.RESULTSImmigrants from 6 countries accounted for 87.3% of active TB cases detected through preimmigration screening, and 10 countries accounted for 80.4% of cases detected through postimmigration surveillance. Immigrants from countries with a TB (all-sites) incidence rate of less than 30 cases per 100 000 persons resulted in pre- and postimmigration detection of 2.4 and 0.9 cases per 100 000 immigrants, respectively. Postimmigration surveillance detected 2.6% of active TB cases in Ontario residents born abroad, and TB was detected a median of 18 days earlier in those undergoing surveillance than in those who were not referred to surveillance or who did not comply. Predictors of active TB postimmigration included radiographic markers of old TB, birth country, immigration category, location of application for residency, immune status and age.INTERPRETATIONUniversal screening for TB in new immigrants has a modest impact on the domestic burden of active TB and is highly inefficient. Focusing preimmigration screening in countries with high incidence rates and revising criteria for postimmigration surveillance could increase the effectiveness and efficiency of screening. Results: Immigrants from 6 countries accounted for 87.3% of active TB cases detected through preimmigration screening, and 10 countries accounted for 80.4% of cases detected through postimmigration surveillance. Immigrants from countries with a TB (all-sites) incidence rate of less than 30 cases per 100 000 persons resulted in pre- and postimmigration detection of 2.4 and 0.9 cases per 100 000 immigrants, respectively. Postimmigration surveillance detected 2.6% of active TB cases in Ontario residents born abroad, and TB was detected a median of 18 days earlier in those undergoing surveillance than in those who were not referred to surveillance or who did not comply. Predictors of active TB postimmigration included radiographic markers of old TB, birth country, immigration category, location of application for residency, immune status and age. Using this linked data set, we calculated 2-year incidence rates of active TB detected among permanent residents who were referred for and compliant with postimmigration surveillance, those who were referred and not compliant, and those who were not referred. We also identified which birth countries accounted for the largest proportion of all active TB cases detected among immigrants. We then calculated the number of preimmigration medical examinations needed to detect a single patient with active (pulmonary) TB (because preimmigration screening emphasizes detection of communicable TB), and the number of preimmigration medical examinations and postimmigration surveillance referrals needed to detect a single patient with active TB (all sites) within 2 years of immigration. These analyses were stratified by immigrants' country of birth (see Appendix 2, available at www.cmaj.ca/lookup/suppl/doi :10.1503/cmaj.150011/-/DC1). More than 1 million immigrants to Canada, Australia, France, New Zealand and the United States, collectively, undergo screening for TB each year; however, our understanding of the impact of this screening is limited.20 A recent large-scale study of US-bound immigrants and refugees identified high rates of smear-negative pulmonary TB (i.e., 3 negative smears with chest radiographic markers suggestive of active TB) on overseas screening, with most cases identified in immigrants from a short list of high-incidence countries.21 Our analysis complements those findings, in that our primary outcome is active TB confirmed through culture, our study period includes up to 10 years' postimmigration followup and we identify person-level risk factors for the future development and timing of active TB. Furthermore, our study differentiates TB risks between overseas and domestic applicants for permanent residency, describes outcomes of TB screening by country of birth and quantifies the potential and actual impact of postimmigration surveillance on the domestic burden of active TB in patients born abroad. |
| Audience | Professional |
| Author | Miniota, Jennifer Rea, Elizabeth Hirji, M. Mustafa Ellis, Edward Chan, Angie Creatore, Maria I. Khan, Kamran Hu, Wei Rawal, Sameer Wang, Jun Gardam, Michael |
| Author_xml | – sequence: 1 givenname: Kamran surname: Khan fullname: Khan, Kamran email: khank@smh.ca organization: Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ont – sequence: 2 givenname: M. Mustafa surname: Hirji fullname: Hirji, M. Mustafa organization: Public Health and Preventive Medicine Residency Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont – sequence: 3 givenname: Jennifer surname: Miniota fullname: Miniota, Jennifer – sequence: 4 givenname: Wei surname: Hu fullname: Hu, Wei – sequence: 5 givenname: Jun surname: Wang fullname: Wang, Jun – sequence: 6 givenname: Angie surname: Chan fullname: Chan, Angie – sequence: 7 givenname: Maria I. surname: Creatore fullname: Creatore, Maria I. – sequence: 8 givenname: Michael surname: Gardam fullname: Gardam, Michael organization: Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ont – sequence: 9 givenname: Sameer surname: Rawal fullname: Rawal, Sameer organization: Faculty of Medicine, University of Toronto, Toronto, Ont – sequence: 10 givenname: Edward surname: Ellis fullname: Ellis, Edward organization: Faculty of Medicine, University of Ottawa, Ottawa, Ont – sequence: 11 givenname: Elizabeth surname: Rea fullname: Rea, Elizabeth organization: Toronto Public Health and Dalla Lana School of Public Health, University of Toronto, Toronto, Ont |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26416993$$D View this record in MEDLINE/PubMed |
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| Copyright | 2015 8872147 Canada Inc. or its licensors 2015 Canadian Medical Association or its licensors. COPYRIGHT 2015 Joule Inc. Copyright 8872147 Canada Inc. Nov 3, 2015 2015 8872147 Canada Inc. or its licensors 2015 |
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| Snippet | All Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration surveillance for the... Background: All Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration... Interpretation: Universal screening for TB in new immigrants has a modest impact on the domestic burden of active TB and is highly inefficient. Focusing... Results: Immigrants from 6 countries accounted for 87.3% of active TB cases detected through preimmigration screening, and 10 countries accounted for 80.4% of... BACKGROUNDAll Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration surveillance... |
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| SubjectTerms | Adolescent Adult Aged Aged, 80 and over Child Child, Preschool Distribution Emigrants and Immigrants - statistics & numerical data Female Health aspects Health screening Humans Immigrants Incidence Infant Infant, Newborn Male Mass Screening - methods Medical diagnosis Medical screening Medical treatment Methods Middle Aged Noncitizens Ontario - epidemiology Program Evaluation Proportional Hazards Models Public health administration Public Health Surveillance - methods Retrospective Studies Tuberculosis Tuberculosis - diagnosis Tuberculosis - epidemiology Tuberculosis - prevention & control Young Adult |
| Title | Domestic impact of tuberculosis screening among new immigrants to Ontario, Canada |
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