title: Higher Rate of Tuberculosis in Second Generation Migrants Compared to Native Residents in a Metropolitan Setting in Western Europe.
abstract: BACKGROUND
  In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We aimed to characterize migration among tuberculosis cases in Berlin and to estimate annual rates of tuberculosis in two subsequent migrant generations. We hypothesized that second generation migrants born in Germany are at higher risk of tuberculosis compared to native (non-migrant) residents.
  
  
  METHODS
  A prospective cross-sectional study was conducted. All tuberculosis cases reported to health authorities in Berlin between 11/2010 and 10/2011 were eligible. Interviews were conducted using a structured questionnaire including demographic data, migration history of patients and their parents, and language use. Tuberculosis rates were estimated using 2011 census data.
  
  
  RESULTS
  Of 314 tuberculosis cases reported, 154 (49.0%) participated. Of these, 81 (52.6%) were first-, 14 (9.1%) were second generation migrants, and 59 (38.3%) were native residents. The tuberculosis rate per 100,000 individuals was 28.3 (95CI: 24.0-32.6) in first-, 10.2 (95%CI: 6.1-16.6) in second generation migrants, and 4.6 (95%CI: 3.7-5.6) in native residents. When combining information from the standard notification variables country of birth and citizenship, the sensitivity to detect second generation migration was 28.6%.
  
  
  CONCLUSIONS
  There is a higher rate of tuberculosis among second generation migrants compared to native residents in Berlin. This may be explained by presumably frequent contact and transmission within migrant populations. Second generation migration is insufficiently captured by the surveillance variables country of birth and citizenship. Surveillance systems in Western Europe should allow for quantifying the tuberculosis burden in this important risk group.
authors.affiliation: Department of Pediatric Pneumology and Immunology, Charité -Universitätsmedizin, Berlin, Germany; Division of Global Health Equity, Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America.
authors.forename: Florian M
authors.initials: FM
authors.lastname: Marx
authors.affiliation: Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Fiebig
authors.affiliation: Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hauer
authors.affiliation: Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Bonita
authors.initials: B
authors.lastname: Brodhun
authors.affiliation: Centre for Tuberculosis, Public Health Office Berlin-Lichtenberg, Berlin, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Glaser-Paschke
authors.affiliation: Department of Pediatric Pneumology and Immunology, Charité -Universitätsmedizin, Berlin, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Magdorf
authors.affiliation: Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Haas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001604:Berlin / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult