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Open Access Research article

Epidemiology of tuberculosis in a low-incidence Italian region with high immigration rates: differences between not Italy-born and Italy-born TB cases

Anna Odone1*, Matteo Riccò1, Matteo Morandi2, Bianca M Borrini3, Cesira Pasquarella1 and Carlo Signorelli1

Author Affiliations

1 Department of Public Health, University of Parma, Parma, Italy

2 Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Area di Programma Rischio Infettivo, Bologna, Italy

3 Servizio Sanità Pubblica - Direzione Generale Sanità e Politiche Sociali - Regione Emilia-Romagna, Italy

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BMC Public Health 2011, 11:376  doi:10.1186/1471-2458-11-376

Published: 23 May 2011

Abstract

Background

Emilia Romagna, a northern Italian region, has a population of 4.27 million, of which 9.7% are immigrants. The objective of this study was to investigate the epidemiology of tuberculosis (TB) during the period 1996-2006 in not Italy-born compared to Italy-born cases.

Methods

Data was obtained from the Regional TB surveillance system, from where personal data, clinical features and risk factors of all notified TB cases were extracted.

Results

5377 TB cases were reported. The proportion of immigrants with TB, over the total number of TB cases had progressively increased over the years, from 19.1% to 53.3%. In the not Italy-born population, TB incidence was higher than in Italians (in 2006: 100.7 cases per 100 000 registered not Italy-born subjects and 83.9/100 000 adding 20% of estimated irregular presences to the denominators. TB incidence among Italians was 6.5/100 000 Italians). A progressive rise in the not Italy-born incident cases was observed but associated with a decline in TB incidence. Not Italy-born cases were younger compared to the Italy-born cases, and more frequently classified as "new cases" (OR 2.0 95%CI 1.61-2.49 for age group 20-39); 60.7% had pulmonary TB, 31.6% extra pulmonary and 7.6% disseminated TB. Risk factors for TB in this population group were connected to lower income status (homeless: OR 149.9 95%CI 20.7-1083.3 for age group 40-59).

Conclusions

In low-incidence regions, prevention and control of TB among sub-groups at risk such as the foreign-born population is a matter of public health concern. In addition, increasing immigration rates may affect TB epidemiology. TB among immigrants is characterized by particular clinical features and risk factors, which should be analyzed in order to plan effective action.