title: Influence of migration on tuberculosis in a semi-urban area.
abstract: OBJECTIVE
  To describe the epidemiology of tuberculosis and analyzing the differences among native and immigrant patients in Area III of the Region of Murcia.
  
  
  METHODS
  Cohort study of tuberculosis cases reported to the Epidemiological Surveillance Service from 2004 to 2009. Data collection was performed through the System of Notification Diseases, reviewing clinical files and epidemiological surveys.
  
  
  RESULTS
  One hundred sixty two cases were detected; 110 (67.9%) were immigrants, whose incidence rates ranged from 43.4 to 101.2 cases per 100,000 inhabitants. Ecuador (42.7%), Bolivia (30%) and Morocco (18.2%) were the main nationalities. Immigrants were younger than Spanish population (P<.001). The overall diagnostic delay was 50.5 days: 59.5 in Spanish and 47 in foreigners. Moroccans had higher proportions of extrapulmonary TB (P=.02). Mainly, immigrant population took treatment with four drugs (P<.001). Natives had better treatment adherence (P=.04). Spanish cases tuberculosis were associated with smoking (P<.001), the same as alcohol consumption (P=.01) and injection drug use (P<.001), nevertheless in the foreign-born population the most relevant risk factor was overcrowding (P<.001).
  
  
  CONCLUSIONS
  The incidence tuberculosis rates are higher among immigrant population, whose the main risk factor is overcrowding. In contrast, Spanish cases are associated with toxic substances consumption and increasing age.
authors.affiliation: Servicio de Salud Pública, Centro de Área de Salud III, Dirección General de Salud Pública, Consejería de Sanidad y Política Social de la Región de Murcia, Lorca, Murcia, España. Electronic address: yolanda.molina@carm.es.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Molina-Salas
authors.affiliation: Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España.
authors.forename: María
authors.initials: M
authors.lastname: de las Mercedes Lomas-Campos
authors.affiliation: Servicio de Salud Pública, Centro de Área de Salud III, Dirección General de Salud Pública, Consejería de Sanidad y Política Social de la Región de Murcia, Lorca, Murcia, España.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Romera-Guirado
authors.affiliation: Departamento de Enfermería, Facultad de Enfermería, Universidad de Murcia, Murcia, España.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Romera-Guirado
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use; D003441:Crowding; D004359:Drug Therapy, Combination; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009018:Morocco / Q000208:ethnology; D009549:Nigeria / Q000208:ethnology; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013020:South America / Q000208:ethnology; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D013383:Suburban Population / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Epidemiology; Epidemiología; Immigration; Incidence; Incidencia; Inmigración; Tuberculosis