title: Social, clinical and microbiological differential characteristics of tuberculosis among immigrants in Spain.
abstract: BACKGROUND
  To identify the differential tuberculosis (TB) characteristics within the immigrant population with respect to natives in Spain.
  
  
  RESULTS
  A prospective cohort study design was implemented to examine the TB cases diagnosed and starting standard antituberculous treatment in Spain, between January 1st 2006 and March 31st 2007. A logistic regression analysis was performed to determine differential characteristics. 1,490 patients were included in the study population, 1,048 natives and 442 (29.7%) immigrants. According to the multivariate analysis, the following variables were significantly associated with immigrant TB cases: younger age (OR = 3.79; CI:2.16-6.62), living in group situation (OR = 7.61; CI:3.38-12.12), lower frequency of disabled (OR:0.08; CI:0.02-0.26) and retired (OR:0.21; CI:0.09-0.48) employment status, lower frequency of pulmonary disease presentation (OR = 0.47; CI:0.24-0.92), primary or emergency care admission (OR = 1.80; CI:1.05-3.06 and OR = 2.16; CI:1.36-3.45), drug resistance (OR = 1.86; CI:1.01-3.46), treatment default (OR:2.12; CI:1.18-3.81), lower frequency of alcohol and cigarette consumption (OR = 2.10; CI:1.42-3.11 and OR = 2.85; CI:2.10-3.87 respectively), more directly observed treatment (OR = 1.68; CI:1.04-2.69), and poor understanding of TB disease and its treatment (OR = 3.11; CI:1.86-5.20). The low percentage of primary MDR-TB in the native population (0.1% vs. 2.2% of immigrants) should be noted.
  
  
  CONCLUSIONS
  The differences show the need to introduce specific strategies in the management of TB within the immigrant population, including the improvement of social and work conditions.
authors.affiliation: Programa Integrado de Investigación en Tuberculosis de la Sociedad Española de Neumología y Cirugía Torácica, Barcelona, Spain. josemaria.garciag@sespa.princast.es
authors.forename: José-María
authors.initials: JM
authors.lastname: García-García
authors.forename: Rafael
authors.initials: R
authors.lastname: Blanquer
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodrigo
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
authors.forename: José A
authors.initials: JA
authors.lastname: Caminero
authors.forename: Rafael
authors.initials: R
authors.lastname: Vidal
authors.forename: Martí
authors.initials: M
authors.lastname: Casals
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz-Manzano
mesh_terms: D015331:Cohort Studies; D054242:Emigrants and Immigrants; D006801:Humans; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology*