title: Epidemiological evaluation of spatiotemporal and genotypic clustering of Mycobacterium tuberculosis in Ontario, Canada.
abstract: BACKGROUND
  In Canada, tuberculosis (TB) rates are at a historic low, with the remaining risk concentrated in a few vulnerable population subgroups.
  
  
  OBJECTIVE
  To describe the epidemiology of TB in the Canadian province of Ontario and to characterise risk factors associated with transmission events, identified using genetic typing techniques.
  
  
  METHODS
  Retrospective analysis of 2186 culture-positive TB cases between August 2007 and December 2011. Temporal trends and risk of spatiotemporal and genotypic clustering were evaluated using Poisson and logistic regression models.
  
  
  RESULTS
  Being in a spatiotemporal cluster was associated with Aboriginal status (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.23-10.71). Cases in genotypic clusters were more likely to report homelessness as a risk factor (adjusted OR [aOR] 2.92, 95%CI 1.74-4.90) or be male (aOR 1.35, 95%CI 1.09-1.68), and were less likely to be aged ≥ 65 years (aOR 0.63, 95%CI 0.49-0.82), foreign-born (aOR 0.32, 95%CI 0.24-0.43) or Aboriginal (aOR 0.40, 95%CI 0.16-0.99). The Beijing lineage had an annual rate of increase of almost 10% (P = 0.047), and was associated with genotypic clustering (aOR 2.84, 95%CI 2.19-3.67).
  
  
  CONCLUSIONS
  Genotypic data suggest that disease clusters are smaller, but far more common, than would be estimated using spatiotemporal clustering.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A R
authors.initials: AR
authors.lastname: Tuite
authors.forename: J L
authors.initials: JL
authors.lastname: Guthrie
authors.forename: D C
authors.initials: DC
authors.lastname: Alexander
authors.forename: M S
authors.initials: MS
authors.lastname: Whelan
authors.forename: B
authors.initials: B
authors.lastname: Lee
authors.forename: K
authors.initials: K
authors.lastname: Lam
authors.forename: J
authors.initials: J
authors.lastname: Ma
authors.forename: D N
authors.initials: DN
authors.lastname: Fisman
authors.forename: F B
authors.initials: FB
authors.lastname: Jamieson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D005260:Female; D005838:Genotype; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D009864:Ontario / Q000453:epidemiology; D016012:Poisson Distribution; D012307:Risk Factors; D012737:Sex Factors; D062211:Spatio-Temporal Analysis; D014376:Tuberculosis / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology