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Comparative Study
. 2013 Jul-Aug;20(4):223-30.
doi: 10.1155/2013/429496. Epub 2013 May 28.

Marked disparity in the epidemiology of tuberculosis among Aboriginal peoples on the Canadian prairies: the challenges and opportunities

Richard Long  1 , Vernon Hoeppner, Pamela Orr, Martha Ainslie, Malcolm King, Sylvia Abonyi, Maria Mayan, Dennis Kunimoto, Deanne Langlois-Klassen, Courtney Heffernan, Angela Lau, Dick Menzies
Affiliations
Comparative Study

Marked disparity in the epidemiology of tuberculosis among Aboriginal peoples on the Canadian prairies: the challenges and opportunities

Richard Long et al. Can Respir J. 2013 Jul-Aug.

Abstract
in English, French

Background: While it is established that Aboriginal peoples in the prairie provinces of Canada are disproportionately affected by tuberculosis (TB), little is known about the epidemiology of TB either within or across provincial borders.

Methods: Provincial reporting systems for TB, Statistics Canada censuses and population estimates of Registered Indians provided by Aboriginal Affairs and Northern Development Canada were used to estimate the overall (2004 to 2008) and pulmonary (2007 to 2008) TB rates in the prairie provinces. The place of residence at diagnosis of pulmonary TB cases in 2007 to 2008 was also documented.

Results: The age- and sex-adjusted incidence of TB in Registered Indians was 52.6 per 100,000 person-years, 38 times higher than in Canadian-born 'others'. Incidence rates in Registered Indians were highest in Manitoba and lowest in Alberta. In Alberta and Saskatchewan, on-reserve rates were more than twice that of off-reserve rates. Rates in the Métis and Registered Indians were similar in Saskatchewan (50.0 and 52.2 per 100,000 person-years, respectively). In 2007 to 2008, approximately 90% of Canadian-born pulmonary TB cases in the prairie provinces were Aboriginal. Outside of one metropolitan area (Winnipeg, Manitoba), most Registered Indian and Métis pulmonary TB cases were concentrated in a relatively small number of communities north of the 53rd parallel. Rates of pulmonary TB in 11 of these communities were >300 per 100,000 person-years. In Manitoba, 49% of off-reserve Registered Indian pulmonary cases were linked to high-incidence reserve communities.

Interpretation: The epidemiology of TB among Aboriginal peoples on the Canadian prairies is markedly disparate. Pulmonary TB is highly focal, which is both a concern and an opportunity.

HISTORIQUE :: Il est établi qu’un nombre disproportionné de membres des peuples autochtones des Prairies canadiennes est atteint de tuberculose (TB), mais on ne sait pas grand-chose de l’épidémiologie de la TB à l’intérieur des frontières provinciales ou entre ces frontières.

MÉTHODOLOGIE :: Les chercheurs ont utilisé les systèmes provinciaux de déclaration de la TB, les recensements de Statistique Canada et les évaluations des populations d’Indiens inscrits fournies par le ministère des Affaires autochtones et du Développement du Nord du Canada pour évaluer le taux de TB global (2004 à 2008) et pulmonaire (2007 et 2008) dans les provinces des Prairies. Ils ont également consigné le lieu de résidence au diagnostic de TB pulmonaire en 2007 et 2008.

RÉSULTATS :: L’incidence de TB rajustée selon l’âge et selon le sexe chez les Indiens inscrits était de 52,6 cas sur 100 000 personnes-années, un taux 38 fois plus élevé que chez les « autres » d’origine canadienne. Le nombre d’Indiens inscrits atteints de TB était plus élevé au Manitoba et moins élevé en Alberta. En Alberta et en Saskatchewan, les taux sur les réserves étaient presque deux fois plus élevés que ceux hors réserve. Le taux observé chez les Métis et les Indiens inscrits était similaire en Saskatchewan (50,0 et 52,2 cas sur 100 000 personnes-années, respectivement). En 2007 et 2008, environ 90 % des cas de TB pulmonaire chez des habitants d’origine canadienne vivant dans les Prairies s’observaient chez des Autochtones. À l’extérieur d’une région métropolitaine (Winnipeg, au Manitoba), la plupart des cas de TB pulmonaire chez les Indiens inscrits et les Métis se concentraient dans un nombre relativement peu élevé de communautés au nord du 53e parallèle. Le taux de TB pulmonaire dans 11 de ces communautés était de plus de 300 cas sur 100 000 personnes-années. Au Manitoba, 49 % des cas de TB pulmonaire chez les Indiens inscrits hors réserve étaient liés à une forte incidence dans les communautés sur les réserves.

INTERPRÉTATION :: L’épidémiologie de la TB au sein des peuples autochtones des Prairies canadienne est très disparate. La TB pulmonaire est fortement localisée, ce qui constitue à la fois une inquiétude et une occasion à saisir.

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Figures

Figure 1)
Figure 1)
Age-sex specific tuberculosis case rates per 100,000 person-yearsin the Prairie Provinces, 2004 to 2008. Rates for male cases are indicated closed (solid) circles and rates for females by open circles. Lines represent different population groups: solid lines, cases among Registered Indians; dashed lines, foreign-born cases; dotted lines, Canadian-born ‘others’ cases
Figure 2)
Figure 2)
Frequency distribution of Registered Indian pulmonary tuberculosis cases according province, reserve community and sputum smear status in 2007 to 2008. Numbers written over the provincial abbreviations refer to the total number of reserve communities in each jurisdiction. AB Alberta; SK Saskatchewan; MB Manitoba; No Number
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