title: Epidemiology of tuberculosis in a low-incidence Italian region with high immigration rates: differences between not Italy-born and Italy-born TB cases.
abstract: BACKGROUND
  Emilia Romagna, a northern Italian region, has a population of 4.27 million, of which 9.7% are immigrants. The objective of this study was to investigate the epidemiology of tuberculosis (TB) during the period 1996-2006 in not Italy-born compared to Italy-born cases.
  
  
  METHODS
  Data was obtained from the Regional TB surveillance system, from where personal data, clinical features and risk factors of all notified TB cases were extracted.
  
  
  RESULTS
  5377 TB cases were reported. The proportion of immigrants with TB, over the total number of TB cases had progressively increased over the years, from 19.1% to 53.3%. In the not Italy-born population, TB incidence was higher than in Italians (in 2006: 100.7 cases per 100,000 registered not Italy-born subjects and 83.9/100,000 adding 20% of estimated irregular presences to the denominators. TB incidence among Italians was 6.5/100,000 Italians). A progressive rise in the not Italy-born incident cases was observed but associated with a decline in TB incidence. Not Italy-born cases were younger compared to the Italy-born cases, and more frequently classified as "new cases" (OR 2.0 95%CI 1.61-2.49 for age group 20-39); 60.7% had pulmonary TB, 31.6% extra pulmonary and 7.6% disseminated TB. Risk factors for TB in this population group were connected to lower income status (homeless: OR 149.9 95%CI 20.7-1083.3 for age group 40-59).
  
  
  CONCLUSIONS
  In low-incidence regions, prevention and control of TB among sub-groups at risk such as the foreign-born population is a matter of public health concern. In addition, increasing immigration rates may affect TB epidemiology. TB among immigrants is characterized by particular clinical features and risk factors, which should be analyzed in order to plan effective action.
authors: Department of Public Health, University of Parma, Parma, Italy. anna.odone@yahoo.it
authors: Anna
authors: A
authors: Odone
authors: Matteo
authors: M
authors: Riccò
authors: Matteo
authors: M
authors: Morandi
authors: Bianca M
authors: BM
authors: Borrini
authors: Cesira
authors: C
authors: Pasquarella
authors: Carlo
authors: C
authors: Signorelli
references: J Clin Microbiol. 2007 Jan;45(1):63-9
references: 17108076
references: JAMA. 2008 Jul 23;300(4):405-12
references: 18647983
references: Euro Surveill. 2009 Mar 19;14(11):
references: 19317977
references: BMC Public Health. 2010 Jun 17;10:349
references: 20565732
references: Assist Inferm Ric. 2008 Jan-Mar;27(1):13-7
references: 18757002
references: Eur Respir J. 2008 Jan;31(1):99-105
references: 17804450
references: BMC Infect Dis. 2009 Dec 31;9:217
references: 20043847
references: Can Commun Dis Rep. 2003 Jan 15;29(2):10-6
references: 12561159
references: Am J Respir Crit Care Med. 1998 Dec;158(6):1797-803
references: 9847270
references: Bull World Health Organ. 2009 Sep;87(9):683-91
references: 19784448
references: JAMA. 2002 Feb 27;287(8):991-5
references: 11866646
references: Clin Infect Dis. 2007 May 15;44(10):1261-7
references: 17443460
references: Med Mal Infect. 2009 Mar;39(3):187-90
references: 19211209
references: Emerg Infect Dis. 2005 Apr;11(4):597-602
references: 15829200
references: Bull World Health Organ. 1993;71(3-4):297-306
references: 8324847
references: Euro Surveill. 2008 Mar 18;13(12):
references: 18761995
references: Int J Tuberc Lung Dis. 2007 Jul;11(7):769-74
references: 17609052
references: Enferm Infecc Microbiol Clin. 2004 Jun-Jul;22(6):315-8
references: 15228896
references: JAMA. 2002 Feb 27;287(8):996-1002
references: 11866647
references: Lancet Infect Dis. 2006 Nov;6(11):710-25
references: 17067920
references: Int J Tuberc Lung Dis. 1999 Jul;3(7):589-95
references: 10423221
references: Eur J Public Health. 2005 Aug;15(4):339-42
references: 15975952
references: Emerg Infect Dis. 2002 Jul;8(7):679-84
references: 12095434
references: Epidemiol Prev. 2008 Mar-Apr;32(2):85-92
references: 18717230
references: Int J Tuberc Lung Dis. 2008 Feb;12(2):193-8
references: 18230253
references: JAMA. 2000 Dec 13;284(22):2894-900
references: 11147986