Abstract
BackgroundIn 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.MethodsA 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.ResultsOf 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%.ConclusionsThere 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.
Highlights
In Europe and globally, tuberculosis remains an important public health challenge
The tuberculosis rate per 100,000 individuals was 28.3 (95CI: 24.0–32.6) in first, 10.2 in second generation migrants, and 4.6 (95%confidence intervals (CI): 3.7–5.6) in native residents
There is a higher rate of tuberculosis among second generation migrants compared to native residents in Berlin
Summary
In Europe and globally, tuberculosis remains an important public health challenge. An increasing share of the tuberculosis burden is associated with international migration [1, 2]. In 2010, individuals of foreign country of birth and/or foreign citizenship accounted for the majority of tuberculosis patients in 8 of the 27 EU member states, reaching 70% in the United Kingdom, 71% in the Netherlands, and 89% in Sweden, for example [3]. Immigration to and within the EU is considered one of the major determinants for changing tuberculosis trends in Western European countries: In the United Kingdom, the increase in tuberculosis incidence observed between 1996 and 2005 was, at least partially, due to cases among foreign-born individuals, many of whom originate from countries with a high burden of the disease [4]. In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We hypothesized that second generation migrants born in Germany are at higher risk of tuberculosis compared to native (non-migrant) residents
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