title: Housing and tuberculosis in an Inuit village in northern Quebec: a case-control study.
abstract: BACKGROUND
  Between November 2011 and November 2012, an Inuit village in Nunavik, Quebec experienced a surge in the occurrence of active TB; contact investigations showed that TB infection was highly prevalent (62.6%), particularly among those over age 14 years (78.8%). A nested case-control study showed that nutritional inadequacy was associated with acquisition of infection but not progression to disease. We performed a study to determine whether characteristics of one's dwelling were associated with 1) acquisition of newly diagnosed TB infection and 2) progression to confirmed or probable disease among those with TB infection.
  
  
  METHODS
  In this nested case-control study, we enrolled 200 people who were household or social contacts of at least 1 person with active TB or had received a diagnosis of active TB and assessed whether characteristics of their dwellings were associated with their odds of having newly diagnosed TB infection and/or odds of progression to disease between November 2011 and November 2012. For our first objective, we compared participants with newly diagnosed TB infection (regardless of their disease status) to a control group of contacts who were uninfected. For the second objective, we compared participants with confirmed or probable disease to a control group consisting of those with infection but no disease. We used information collected during investigation of the contacts and from study questionnaires to determine whether participants may have been exposed to TB in their own home (if they had shared a dwelling with someone who had smear-positive TB during the outbreak) or in other dwellings that they visited at least weekly.
  
  
  RESULTS
  The participants lived in 79 dwellings. The mean number of people per room was 1.1 (standard deviation [SD] 0.5). The mean room size and ventilation level of the common living space (kitchen and living/dining rooms) were 67.9 (SD 9.4) m3 and 1.69 (SD 0.26) air changes per hour, respectively. After adjustment for potential confounders, the number of people per room was positively associated with the odds of newly diagnosed infection and odds of disease, but only among participants who lived with someone with smear-positive TB (the minority of participants). Other dwelling characteristics were not associated with either outcome.
  
  
  CONCLUSIONS
  Reducing household crowding may contribute to TB prevention. Overall, our investigations have not identified associations that explain the elevated disease risk in this village. In light of our results and considering the high prevalence of TB infection, treatment of latent infection is an essential intervention for long-term reduction of TB incidence in this village.
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Faiz Ahmad
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Fox
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Robyn S
authors.initials: RS
authors.lastname: Lee
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Mylene
authors.initials: M
authors.lastname: Riva
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Proulx
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Shelley
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Karen
authors.initials: K
authors.lastname: Hornby
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Behr
authors.affiliation: Department of Medicine (Ahmad Khan, Benedetti, Behr, Menzies), McGill University; McGill International TB Centre (Ahmad Khan, Fox, Lee, Behr, Menzies); Respiratory Epidemiology and Clinical Research Unit (Ahmad Khan, Fox, Jung, Hornby, Menzies), Montreal Chest Institute; Department of Epidemiology, Biostatistics and Occupational Health (Lee, Benedetti), McGill University; Institute for Health and Social Policy (Riva), McGill University; Department of Geography (Riva), McGill University, Montréal, Que.; Department of Public Health (Proulx), Nunavik Regional Board of Health and Social Services, Kuujjuaq, Que.
authors.forename: Dick
authors.initials: D
authors.lastname: Menzies