1887
  1. Home
  2. Eurosurveillance
  3. Volume 24, Issue 44, 31/Oct/2019
  4. Article
Research Open Access
Like 0
Download

Abstract

Background

Migrants account for the majority of tuberculosis (TB) cases in low-incidence countries in western Europe. TB incidence among migrants might be influenced by patterns of migration, but this is not well understood.

Aim

To investigate differences in TB risk across migrant groups according to migrant status and region of origin.

Methods

This prospective cohort study included migrants ≥ 18 years of age who obtained residency in Denmark between 1 January 1993 and 31 December 2015, matched 1:6 to Danish-born individuals. Migrants were grouped according to legal status of residency and region of origin. Incidence rates (IR) and incidence rate ratios (IRR) were estimated by Poisson regression.

Results

The cohort included 142,314 migrants. Migrants had significantly higher TB incidence (IR: 120/100,000 person-years (PY); 95% confidence interval (CI): 115–126) than Danish-born individuals (IR: 4/100,000 PY; 95% CI: 3–4). The IRR was significantly higher in all migrant groups compared with Danish-born (p < 0.01). A particularly higher risk was seen among family-reunified to refugees (IRR: 61.8; 95% CI: 52.7–72.4), quota refugees (IRR: 46.0; 95% CI: 36.6–57.6) and former asylum seekers (IRR: 45.3; 95% CI: 40.2–51.1), whereas lower risk was seen among family-reunified to Danish/Nordic citizens (IRR 15.8; 95% CI: 13.6–18.4) and family-reunified to immigrants (IRR: 16.9; 95% CI: 13.5–21.3).

Discussion

All migrants had higher TB risk compared with the Danish-born population. While screening programmes focus mostly on asylum seekers, other migrant groups with high risk of TB are missed. Awareness of TB risk in all high-risk groups should be strengthened and screening programmes should be optimised.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2019.24.44.1900238
2019-10-31
2024-11-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.44.1900238
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/24/44/eurosurv-24-44-2.html?itemId=/content/10.2807/1560-7917.ES.2019.24.44.1900238&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Framework towards tuberculosis elimination in low-Incidence countries. Geneva: WHO; 2014. Available from: http://who.int/tb/publications/elimination_framework/en/
  2. Pareek M, Greenaway C, Noori T, Munoz J, Zenner D. The impact of migration on tuberculosis epidemiology and control in high-income countries: a review. BMC Med. 2016;14(1):48.  https://doi.org/10.1186/s12916-016-0595-5  PMID: 27004556 
  3. World Health Organization (WHO). Tuberculosis country profile. Geneva: WHO;2017. Available from: https://www.who.int/tb/country/data/profiles/en/
  4. Lönnroth K, Mor Z, Erkens C, Bruchfeld J, Nathavitharana RR, van der Werf MJ, et al. Tuberculosis in migrants in low-incidence countries: epidemiology and intervention entry points. Int J Tuberc Lung Dis. 2017;21(6):624-37.  https://doi.org/10.5588/ijtld.16.0845  PMID: 28482956 
  5. European Centre for Disease Prevention and Control (ECDC). Tuberculosis in Europe: From passive control to active elimination. Stockholm: ECDC; 2015. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/tuberculosis-evidence-brief-low-high-incidence-countries.pdf
  6. Lillebaek T, Andersen ÅB, Dirksen A, Smith E, Skovgaard LT, Kok-Jensen A. Persistent high incidence of tuberculosis in immigrants in a low-incidence country. Emerg Infect Dis. 2002;8(7):679-84.  https://doi.org/10.3201/eid0807.010482  PMID: 12095434 
  7. Vos AM, Meima A, Verver S, Looman CWN, Bos V, Borgdorff MW, et al. High incidence of pulmonary tuberculosis persists a decade after immigration, The Netherlands. Emerg Infect Dis. 2004;10(4):736-9.  https://doi.org/10.3201/eid1004.030530  PMID: 15200873 
  8. McPherson ME, Kelly H, Patel MS, Leslie D. Persistent risk of tuberculosis in migrants a decade after arrival in Australia. Med J Aust. 2008;188(9):528-31.  https://doi.org/10.5694/j.1326-5377.2008.tb01768.x  PMID: 18459925 
  9. Aldridge RW, Zenner D, White PJ, Williamson EJ, Muzyamba MC, Dhavan P, et al. Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland. Lancet. 2016;388(10059):2510-8.  https://doi.org/10.1016/S0140-6736(16)31008-X  PMID: 27742165 
  10. Castelli F, Sulis G. Migration and infectious diseases. Clin Microbiol Infect. 2017;23(5):283-9.  https://doi.org/10.1016/j.cmi.2017.03.012  PMID: 28336382 
  11. Gebrezgi MT, Jimenez A, Ibanez GE. Behind the figures: High active tuberculosis cases among Eritrean asylum seekers in Germany. Int J Hyg Environ Health. 2017;220(5):886.  https://doi.org/10.1016/j.ijheh.2017.04.004  PMID: 28479080 
  12. de Vries SG, Cremers AL, Heuvelings CC, Greve PF, Visser BJ, Bélard S, et al. Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature. Lancet Infect Dis. 2017;17(5):e128-43.  https://doi.org/10.1016/S1473-3099(16)30531-X  PMID: 28291721 
  13. Dara M, Solovic I, Sotgiu G, D’Ambrosio L, Centis R, Tran R, et al. Tuberculosis care among refugees arriving in Europe: a ERS/WHO Europe Region survey of current practices. Eur Respir J. 2016;48(3):808-17.  https://doi.org/10.1183/13993003.00840-2016  PMID: 27492827 
  14. Kristensen KL, Nørredam M, Lillebæk T, Munk-Andersen E, Ravn P. [Tuberculosis among asylum seekers]. Ugeskr Laeger. 2018;180(19):V11170828. PMID: 29761774 
  15. Norredam M, Olsbjerg M, Petersen JH, Bygbjerg I, Krasnik A. Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study. Trop Med Int Health. 2012;17(2):223-30.  https://doi.org/10.1111/j.1365-3156.2011.02901.x  PMID: 22032340 
  16. Lönnroth K, Shah NS, Lange C. State-of-the-art series on tuberculosis and migration. Int J Tuberc Lung Dis. 2016;20(10):1280-1.  https://doi.org/10.5588/ijtld.16.0543  PMID: 27725031 
  17. Ronald LA, Campbell JR, Balshaw RF, Romanowski K, Roth DZ, Marra F, et al. Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study. CMAJ. 2018;190(8):E209-16.  https://doi.org/10.1503/cmaj.170817  PMID: 29483329 
  18. Basu Roy R, Whittaker E, Seddon JA, Kampmann B. Tuberculosis susceptibility and protection in children. Lancet Infect Dis. 2019;19(3):e96-108.  https://doi.org/10.1016/S1473-3099(18)30157-9  PMID: 30322790 
  19. Norredam M, Garcia-Lopez A, Keiding N, Krasnik A. Excess use of coercive measures in psychiatry among migrants compared with native Danes. Acta Psychiatr Scand. 2010;121(2):143-51.  https://doi.org/10.1111/j.1600-0447.2009.01418.x  PMID: 19594483 
  20. Nørredam M. Migration and health: exploring the role of migrant status through register-based studies. Dan Med J. 2015;62(4):B5068. PMID: 25872539 
  21. The World Bank. Countries and Economies. Washington: The World Bank. [Accessed 23 Oct 2019]. Available from: https://data.worldbank.org/country
  22. World Health Organization (WHO). Global tuberculosis report 2018. Geneva: World Health Organization; 2018. Available from: https://www.who.int/tb/publications/global_report/archive/en/
  23. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JPSTROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-9.  https://doi.org/10.1016/j.ijsu.2014.07.013  PMID: 25046131 
  24. Erkens C, Slump E, Kamphorst M, Keizer S, van Gerven PJHJ, Bwire R, et al. Coverage and yield of entry and follow-up screening for tuberculosis among new immigrants. Eur Respir J. 2008;32(1):153-61.  https://doi.org/10.1183/09031936.00137907  PMID: 18287123 
  25. Kaushik N, Lowbridge C, Scandurra G, Dobler CC. Post-migration follow-up programme for migrants at increased risk of developing tuberculosis: a cohort study. ERJ Open Res. 2018;4(3):00008-02018.  https://doi.org/10.1183/23120541.00008-2018  PMID: 30018973 
  26. Farah MG, Meyer HE, Selmer R, Heldal E, Bjune G. Long-term risk of tuberculosis among immigrants in Norway. Int J Epidemiol. 2005;34(5):1005-11.  https://doi.org/10.1093/ije/dyi058  PMID: 15802379 
  27. Svensson E, Millet J, Lindqvist A, Olsson M, Ridell M, Rastogi NWestern Sweden Tuberculosis Epidemiology Study Group. Impact of immigration on tuberculosis epidemiology in a low-incidence country. Clin Microbiol Infect. 2011;17(6):881-7.  https://doi.org/10.1111/j.1469-0691.2010.03358.x  PMID: 20825440 
  28. Jensen SG, Olsen NW, Seersholm N, Lillebaek T, Wilcke T, Pedersen MK, et al. Screening for TB by sputum culture in high-risk groups in Copenhagen, Denmark: a novel and promising approach. Thorax. 2015;70(10):979-83.  https://doi.org/10.1136/thoraxjnl-2015-207162  PMID: 26156525 
  29. Arshad S, Bavan L, Gajari K, Paget SNJ, Baussano I. Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis. Eur Respir J. 2010;35(6):1336-45.  https://doi.org/10.1183/09031936.00054709  PMID: 19840970 
  30. Farah MG, Tverdal A, Selmer R, Heldal E, Bjune G. Tuberculosis in Norway by country of birth, 1986-1999. Int J Tuberc Lung Dis. 2003;7(3):232-5. PMID: 12661836 
  31. Guzman Herrador BR, Rønning K, Borgen K, Mannsåker T, Dahle UR. Description of the largest cluster of tuberculosis notified in Norway 1997-2011: is the Norwegian tuberculosis control programme serving its purpose for high risk groups? BMC Public Health. 2015;15(1):367.  https://doi.org/10.1186/s12889-015-1701-x  PMID: 25879411 
  32. Vanino E, Tadolini M, Attard L, Po C, Francia F, Giannini A, et al. Systematic Tuberculosis Screening in Asylum Seekers in Italy. Clin Infect Dis. 2017;65(8):1407-9.  https://doi.org/10.1093/cid/cix503  PMID: 29017255 
  33. Hamers FF, Downs AM. The changing face of the HIV epidemic in western Europe: what are the implications for public health policies? Lancet. 2004;364(9428):83-94.  https://doi.org/10.1016/S0140-6736(04)16594-X  PMID: 15234861 
  34. World Health Organization (WHO). HIV/AIDS. Data and statistics. Geneva: WHO; 2018. [Accessed 7 Jul 2019]. Available from: https://www.who.int/hiv/data/en/
  35. Deen L, Cowan S, Wejse C, Petersen JH, Norredam MESCMID Study Group for Infections in Travellers and Migrants. Refugees and family-reunified immigrants have a high incidence of HIV diagnosis and late presentation compared with Danish born: a nationwide register-based cohort study. Infection. 2018;46(5):659-67.  https://doi.org/10.1007/s15010-018-1167-8  PMID: 29971691 
  36. Bozorgmehr K, Razum O, Saure D, Joggerst B, Szecsenyi J, Stock C. Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis. Euro Surveill. 2017;22(12):30491.  https://doi.org/10.2807/1560-7917.ES.2017.22.12.30491  PMID: 28367795 
  37. Seedat F, Hargreaves S, Nellums LB, Ouyang J, Brown M, Friedland JS. How effective are approaches to migrant screening for infectious diseases in Europe? A systematic review. Lancet Infect Dis. 2018;18(9):e259-71.  https://doi.org/10.1016/S1473-3099(18)30117-8  PMID: 29778396 
  38. Hvass AMF, Wejse C. Systematic health screening of refugees after resettlement in recipient countries: a scoping review. Ann Hum Biol. 2017;44(5):475-83.  https://doi.org/10.1080/03014460.2017.1330897  PMID: 28562071 
  39. Hvidtfeldt C, Schultz-Nielsen ML. Flygtninge og asylansøgere i Danmark 1992-2016. Antal, ventetid, bosætning og lovgivning. [Refugees and asylum seekers in Demark 1992-2016. Number, waiting time, settlement and legislation]. Copenhagen: ROCKWOOL Fondens Forskningsenhed; 2017. Danish. Available from: https://www.rockwoolfonden.dk/app/uploads/2017/10/Arbejdspapir-50-Flygtninge-og-asylans%C3%B8gere-i-Danmark-1992-2016.pdf
  40. International Organization for Migration (IOM). Key Migration Terms. Geneva: IOM. [Accessed 7 Jul 2019]. Available from: http://www.iom.int/key-migration-terms
  41. The Danish Immigration Service. New to Denmark. Words and concepts. Copenhangen: The Danish Immigration Service; 2018. [Accessed 23 Oct 2019]. Available from: https://www.nyidanmark.dk/en-GB/Words%20and%20Concepts%20Front%20Page
Tuberculosis incidence among migrants according to migrant status: a cohort study, Denmark, 1993 to 2015
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Kristina+Langholz+Kristensen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Langholz Kristensen Kristina</a>, <a href="/search?value1=Troels+Lillebaek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lillebaek Troels</a>, <a href="/search?value1=Joergen+Holm+Petersen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Holm Petersen Joergen</a>, <a href="/search?value1=Sally+Hargreaves&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hargreaves Sally</a>, <a href="/search?value1=Laura+B+Nellums&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nellums Laura B</a>, <a href="/search?value1=Jon+S+Friedland&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Friedland Jon S</a>, <a href="/search?value1=Peter+Henrik+Andersen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Andersen Peter Henrik</a>, <a href="/search?value1=Pernille+Ravn&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ravn Pernille</a>, <a href="/search?value1=Marie+Norredam&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Norredam Marie</a></span>. Tuberculosis incidence among migrants according to migrant status: a cohort study, Denmark, 1993 to 2015. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(44):pii=1900238. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.44.1900238" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.44.1900238</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 10 Apr 2019;&nbsp;&nbsp; <span class="generated">Accepted</span>: 09 Aug 2019 </span> </p>
/content/10.2807/1560-7917.ES.2019.24.44.1900238
/content/10.2807/1560-7917.ES.2019.24.44.1900238
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error