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Int J Tuberc Lung Dis. 2011 Jul;15(7):899-905. doi: 10.5588/ijtld.10.0556.

Local epidemic history as a predictor of tuberculosis incidence in Saskatchewan Aboriginal communities.

Author information

1
Division of Infectious Diseases, School of Medicine, Stanford University, Stanford, California 94305-5323, USA. pepperc@stanford.edu

Abstract

BACKGROUND:

Average tuberculosis (TB) incidence rates are high in Canadian Aboriginal communities, but there is significant variability within this group.

OBJECTIVE:

To determine whether local history of post-contact TB epidemics is predictive of contemporary epidemiology among Aboriginal communities in Saskatchewan, Canada.

METHODS:

TB incidence, age-specific morbidity patterns and rates of clustering of TB genotypes from 1986 to 2004 were compared between two groups of communities: Group 1, in which post-contact epidemics of TB were established around 1870, and Group 2, in which they were delayed until after 1920. Concomitant effects of socio-economic and geographic variables were explored with multivariate models.

RESULTS:

Group 2 communities were characterized by higher annual incidence of TB (median 431 per 100,000 population vs. 38/100,000). In multivariate models that included socio-economic and geographic variables, historical grouping remained a significant independent predictor of community incidence of TB. Clustering of TB genotypes was associated with Group 2 (OR 8.7, 95%CI 3.3-22.7) and age 10-34 years (OR 2.5, 95%CI 1.1-5.7).

CONCLUSIONS:

TB transmission dynamics can vary significantly as a function of a population's historical experience with TB. Populations at different stages along the epidemic trajectory may be amenable to different types of interventions.

PMID:
21682962
PMCID:
PMC3292043
DOI:
10.5588/ijtld.10.0556
[Indexed for MEDLINE]
Free PMC Article
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