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

Tuberculosis (TB) among refugee minors in low-incidence countries remains underexplored. We estimated the incidence of TB disease among refugee minors compared to Danish-born minors.

This nationwide prospective historical cohort study included 31 172 refugee minors (< 18 years) granted residency in Denmark from 1993 to 2015. Each was matched 1:6 with a Danish-born control on age and sex. Follow-up extended from the date of residency until the earliest of: TB diagnosis, the age of 21 years, or study-end (31.12.2015). Data were obtained from Statistics Denmark and the International Reference Laboratory of Mycobacteriology. We conducted descriptive analyses and estimated incidence rates (IRs) using Poisson regression.

Refugee minors had a 48 times higher TB IR compared to their Danish-born peers. Notably, refugee minors from sub-Saharan Africa had an IR of 203 per 100 000 person-years. For both refugee minors and their Danish-born peers, pulmonary TB was the most common form, but still more than a third had extrapulmonary manifestations. Among refugee minors, most TB cases were diagnosed more than 2 years after arrival.

Our findings underscore the need for national policies and clinical guidelines for TB screening of all refugee minors upon arrival to reduce morbidity and advance TB elimination efforts.