Population-based risk factors for tuberculosis and adverse outcomes among Tibetan refugees in India, 1994-1996.
METHODS
Tibetan refugees in India, 1994-1996.


OBJECTIVE
To determine tuberculosis (TB) incidence, independent risk factors for TB, and predictors of adverse outcomes.


METHODS
Data from a house-to-house census/demographic survey were merged with TB patient data. Separate multivariable models for each birthplace were developed for outcomes of interest.


RESULTS
From 1994 to 1996, 47,491 Tibetans were surveyed and 1197 TB cases confirmed (incidence 835/ 100,000). Risk factors for TB in separate multivariable models differed by place of birth. Independent predictors of death for Tibet-born refugees included age >50 years, extra-pulmonary TB, and second-line therapy, while for India-born refugees they included second-line therapy and no improvement at the end of treatment. No significant risk factors for default were identified for Tibet-born refugees, while region of residence and the absence of a BCG scar were independent predictors among those born in India. Predictors of receipt of second-line therapy among Tibet-born refugees included region, years in camps, and prior TB, while among those born in India they were region, age > or =20 years, sputum-positive at diagnosis, and previous TB.


CONCLUSIONS
TB incidence in Tibetan refugee settlements exceeds the highest national TB rates, and country of birth determines risk factors. TB control efforts in India should include this population.
Nelson
L J
LJ
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. lbn9@cdc.gov
Naik
Y
Y
Tsering
K
K
Cegielski
J P
JP
D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012036:Refugees; D012307:Risk Factors; D018609:Tibet / Q000208:ethnology; D014376:Tuberculosis / Q000453:epidemiology*