High Tuberculosis Incidence Among Refugee Minors in Denmark: A Register-Based Cohort Study

Area of Science:

• Public Health
• Epidemiology
• Infectious Diseases

Background:

• Tuberculosis (TB) incidence among refugee minors in low-incidence nations is understudied.
• Understanding TB disease burden in this vulnerable population is critical for public health initiatives.

Purpose of the Study:

• To estimate and compare the incidence of TB disease in refugee minors versus Danish-born minors.
• To inform national policies and clinical guidelines for TB screening in refugee populations.

Main Methods:

• Nationwide prospective historical cohort study of 31,172 refugee minors (under 18) granted residency in Denmark (1993-2015).
• 1:6 matching with Danish-born controls by age and sex.
• Incidence rates (IRs) estimated using Poisson regression with follow-up until TB diagnosis, age 21, or study end (31.12.2015).

Main Results:

• Refugee minors exhibited a 48-fold higher TB incidence rate (IR) compared to Danish-born peers.
• Refugee minors from sub-Saharan Africa had an IR of 203 per 100,000 person-years.
• Over one-third of cases in both groups had extrapulmonary TB; most refugee TB cases were diagnosed >2 years post-arrival.

Conclusions:

• Findings highlight a substantial TB burden among refugee minors in Denmark.
• Urgent need for national policies and clinical guidelines for TB screening upon arrival for all refugee minors.
• Implementing screening can reduce morbidity and support global TB elimination goals.