title: Predicting tuberculosis risk in the foreign-born population of British Columbia, Canada: study protocol for a retrospective population-based cohort study.
abstract: Improved understanding of risk factors for developing active tuberculosis (TB) will better inform decisions about diagnostic testing and treatment for latent TB infection (LTBI) in migrant populations in low-incidence regions. We aim to examine TB risk factors among the foreign-born population in British Columbia (BC), Canada, and to create and validate a clinically relevant multivariate risk score to predict active TB.
  
  
  
  This retrospective population-based cohort study will include all foreign-born individuals who acquired permanent resident status in Canada between 1 January 1985 and 31 December 2013 and acquired healthcare coverage in BC at any point during this period. Multiple administrative databases and disease registries will be linked, including a National Immigration Database, BC Provincial Health Insurance Registration, physician billings, hospitalisations, drugs dispensed from community pharmacies, vital statistics, HIV testing and notifications, cancer, chronic kidney disease and dialysis treatment, and all TB and LTBI testing and treatment data in BC. Extended proportional hazards regression will be used to estimate risk factors for TB and to create a prognostic TB risk score.
  
  
  
  Ethical approval for this study has been obtained from the University of British Columbia Clinical Ethics Review Board. Once completed, study findings will be presented at conferences and published in peer-reviewed journals. An online TB risk score calculator will also be created.
authors.affiliation: Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.|BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Ronald
authors.affiliation: Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jonathon R
authors.initials: JR
authors.lastname: Campbell
authors.affiliation: BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Balshaw
authors.affiliation: BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: David Z
authors.initials: DZ
authors.lastname: Roth
authors.affiliation: BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: Kamila
authors.initials: K
authors.lastname: Romanowski
authors.affiliation: Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Fawziah
authors.initials: F
authors.lastname: Marra
authors.affiliation: Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.|BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Cook
authors.affiliation: Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.|BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: James C
authors.initials: JC
authors.lastname: Johnston
mesh_terms: D001955:British Columbia / Q000453:epidemiology; D016208:Databases, Factual; D054242:Emigrants and Immigrants; D006801:Humans; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014376:Tuberculosis / Q000208:ethnology*
keywords: latent tuberculosis infection; risk score