title: Impact of country of origin on drug-resistant tuberculosis among foreign-born persons in British Columbia.
abstract: METHODS
  Provincial tuberculosis (TB) services, British Columbia, Canada.
  
  
  OBJECTIVE
  To estimate the risk of drug resistance among foreign-born TB patients and to identify risk factors associated with drug resistance.
  
  
  METHODS
  Using the provincial TB database, we examined all culture-positive foreign-born TB patients for the years 1990-2001. The risk of having a drug-resistant isolate was estimated according to country and region of origin.
  
  
  RESULTS
  Of 1940 foreign-born patients identified, 247 (12.7%, 95%CI 11.3-14.3) cases had isolates resistant to at least one of the first-line drugs, with 160 (8.3%) isolates showing monoresistance, 24 (1.2%) multidrug resistance (resistance to at least isoniazid and rifampin) and 63 (3.3%) polyresistance (resistance to two or more drugs, excluding MDR). Country-specific analysis showed that immigrants from Vietnam (adjusted OR 2.12, 95%CI 1.37-3.27) and the Philippines (adjusted OR 1.71, 95%CI 1.10-2.66) had a significantly higher risk of resistance than other immigrants. In addition, the risk was the highest for younger TB patients and patients with reactivated disease (adjusted OR 2.12, 95%CI 1.09-4.09).
  
  
  CONCLUSIONS
  The risk of drug resistance was the highest among foreign-born patients from Vietnam and the Philippines. These findings should assist clinicians in prescribing and tailoring anti-tuberculosis regimens for immigrants more appropriately.
authors.affiliation: Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada. akmubc@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Moniruzzaman
authors.forename: R K
authors.initials: RK
authors.lastname: Elwood
authors.forename: M
authors.initials: M
authors.lastname: Schulzer
authors.forename: J M
authors.initials: JM
authors.lastname: FitzGerald
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D001955:British Columbia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects / Q000208:ethnology; D004641:Emigration and Immigration; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007538:Isoniazid / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D016017:Odds Ratio; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors; D013307:Streptomycin / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin