Setting: DeKalb County, Georgia.
Objectives: To calculate and compare tuberculosis (TB) rates in refugees to US-born, total foreign-born (refugee and other), and other foreign-born persons and to determine the contribution of refugees to the county TB case burden.
Methods: The study included: (1) collection of county TB case numbers and population figures from 1995 through 1999; (2) estimation of the refugee population; (3) comparison of TB rates; and (4) calculation of the refugee TB case burden. Sensitivity analysis was performed on refugee population estimates.
Results: From 1995 through 1999, estimating that refugees made up 10% of the foreign-born population, the average TB rate for refugees was 83.2 per 100,000, compared with 12.7 for US-born persons. From 1997 through 1999, refugees had a seven-fold greater risk of having TB than US-born persons and a two-fold greater risk than other foreign-born persons. Refugees represented respectively 7.6% and 19.3% of the county and foreign-born TB case burdens. For TB rates to be equal among all foreign-born persons, refugees would need to make up 15-25% of the foreign-born population.
Conclusion: Despite overseas screening, refugees have high TB rates, and contribute substantially to the county TB case burden. Enhanced surveillance and targeted programs to address TB in refugees should be a public health priority.