A population-based study of tuberculosis epidemiology and innovative service delivery in Canada

Int J Tuberc Lung Dis. 2012 Jan;16(1):43-9, i. doi: 10.5588/ijtld.11.0374.


Objective: To compare and interpret tuberculosis (TB) incidence rates in a Canadian population across two decennials (1989-1998 and 1999-2008) as a benchmark for World Health Organization targets and the long-term goal of TB elimination. The population under study was served by two urban clinics in the first decennial and two urban and one provincial clinic in the second.

Methods: TB rates among Status Indians, Canadian-born 'others' and the foreign-born were estimated using provincial and national databases. Program performance was measured in on-reserve Status Indians in each decennial.

Results: In each decennial, the incidence rate in Status Indians and the foreign-born was greater than that in the Canadian-born 'others'; respectively 27.7 and 33.0 times in Status Indians, and 8.0 and 20.9 times in the foreign-born. Between decennials, the rate fell by 56% in Status Indians, 58% in Canadian-born 'others', and 18% in the foreign-born. On-reserve Status Indians had higher rates than off-reserve Status Indians, and the three-clinic model out-performed the two-clinic model among those on-reserve. Rates in the foreign-born varied by World Bank region, and were highest among those from Africa and Asia.

Conclusion: Status Indians and the foreign-born are at increased risk of TB in Canada. Significant progress towards TB elimination has been made in Status Indians but not in the foreign-born.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alberta / epidemiology
  • American Indian or Alaska Native / statistics & numerical data*
  • Benchmarking
  • Delivery of Health Care, Integrated / organization & administration*
  • Delivery of Health Care, Integrated / standards
  • Emigrants and Immigrants / statistics & numerical data*
  • Emigration and Immigration / statistics & numerical data*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Organizational Innovation
  • Program Development
  • Program Evaluation
  • Risk Assessment
  • Risk Factors
  • Rural Health Services / organization & administration*
  • Rural Health Services / standards
  • Time Factors
  • Tuberculosis / diagnosis
  • Tuberculosis / epidemiology*
  • Tuberculosis / ethnology
  • Tuberculosis / therapy*
  • Urban Health Services / organization & administration*
  • Urban Health Services / standards
  • World Health Organization
  • Young Adult