title: A population-based study of tuberculosis epidemiology and innovative service delivery in Canada.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Tuberculosis Program Evaluation and Research Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Jensen
authors.forename: A
authors.initials: A
authors.lastname: Lau
authors.forename: D
authors.initials: D
authors.lastname: Langlois-Klassen
authors.forename: J
authors.initials: J
authors.lastname: Boffa
authors.forename: J
authors.initials: J
authors.lastname: Manfreda
authors.forename: R
authors.initials: R
authors.lastname: Long
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D044467:American Indian or Alaska Native / Q000706:statistics & numerical data*; D019985:Benchmarking; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D016730:Program Development; D015397:Program Evaluation; D018570:Risk Assessment; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy*; D019037:Urban Health Services / Q000458:organization & administration* / Q000592:standards; D014944:World Health Organization; D055815:Young Adult