title: Tuberculosis in native- and foreign-born populations in Portugal.
abstract: BACKGROUND
  Tuberculosis (TB) is a major global health problem, and during the last 20 years, industrialised countries have shown similar patterns in TB notifications: decreasing TB incidence in native populations and increasing incidence in foreign-born populations.
  
  
  OBJECTIVE
  To characterise risk factors associated with TB among native- and foreign-born TB patients in Portugal and identify barriers to the management of foreign cases.
  
  
  METHODS
  Analysis of the data from the national tuberculosis surveillance system and data from an online survey of physicians managing TB cases in the country.
  
  
  RESULTS
  Risk factors in the two populations differed. Foreign-born patients were younger, less likely to use drugs or alcohol and had fewer comorbidities. They were also more likely to be human immunodeficiency virus positive, to be employed and to be homeless/living in shelters. The outcome of the disease and the time to diagnosis were not significantly different between the two populations. The most important barriers to the management of foreign-born TB cases were language and fear of deportation.
  
  
  CONCLUSIONS
  As there are significant differences between the two populations, different TB control strategies should be implemented in the two populations.
authors.affiliation: Faculty of Medicine, University of Porto, Praça de Gomes Teixeira, 4099-002 Porto, Portugal. joaot.paulino@sapo.pt.
authors.forename: J
authors.initials: J
authors.lastname: Paulino
authors.affiliation: Epidemiology Unit, Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Martins
authors.affiliation: Department of Mathematic, Faculty of Sciences, University of Porto, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Machado
authors.affiliation: Epidemiology Unit, Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Gomes
authors.affiliation: Department of Mathematic, Faculty of Sciences, and Centre of Mathematics, University of Porto, Porto, Portugal.
authors.forename: A R
authors.initials: AR
authors.lastname: Gaio
authors.affiliation: Epidemiology Unit, Institute of Public Health, and Chest Disease Centre, Vila Nova de Gaia, and Pulmonology, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, and Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Duarte
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D054242:Emigrants and Immigrants; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult