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Bone and joint tuberculosis in Denmark: increase due to immigration
S Houshian1, S Poulsen, P Riegels-Nielsen
1Department of Orthopedics, Esbjerg County Hospital, Copenhagen, Denmark.
Acta Orthopaedica Scandinavica
|August 5, 2000
Summary
Bone and joint tuberculosis (TB) incidence remained stable, but cases shifted from older Danes to younger immigrants, primarily from Somalia. Diagnosis delays were common, highlighting the need for increased awareness in at-risk immigrant populations.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Bone and joint tuberculosis (TB) is a significant extrapulmonary manifestation of TB.
- Understanding the epidemiological trends of bone and joint TB is crucial for targeted public health interventions.
- Previous studies in Denmark indicated a different demographic profile for this condition.
Purpose of the Study:
- To analyze the epidemiology of bone and joint tuberculosis in Denmark between 1993 and 1997.
- To identify trends in incidence, affected demographics, and common sites of infection.
- To compare current trends with historical data and investigate contributing factors.
Main Methods:
- Utilized data from the national Danish Tuberculosis (TB) register.
- Analyzed 95 cases of bone and joint TB diagnosed between 1993 and 1997.
- Calculated incidence rates for native Danes and immigrants, and analyzed demographic and clinical characteristics.
Main Results:
- A total of 95 bone and joint TB cases were identified, representing 4% of all TB cases and 15% of extrapulmonary TB.
- Mean annual incidence was 0.4 per 10^5 population.
- While incidence among native Danes remained low (0.1 per 10^5) with a median age of 66, cases among immigrants significantly increased, with 69 cases (mean age 35) and an incidence of 4 per 10^5.
- The spine was the most commonly affected site (50% of cases).
- Ethnicity was the primary risk factor identified, with a notable increase linked to recent immigration from Somalia.
- Diagnosis was frequently delayed by months to years.
Conclusions:
- The epidemiology of bone and joint TB in Denmark has shifted, with a marked increase in cases among young immigrants, particularly from Somalia.
- Delayed diagnosis remains a challenge, necessitating heightened clinical suspicion in this demographic.
- Public health strategies should focus on early detection and management of bone and joint TB in immigrant populations from TB-endemic regions.