Tb Epidemiology in Canada
Number of Active TB Cases in Canada 2020*
*Public Health Agency of Canada – Tuberculosis: Monitoring 2022
Incidence Rate of Active TB in Canada By Province & Territory (2017) TB incidence rates per 100,000 population by province and territory in Canada, 2017. (Source: LaFreniere M, Hussain H, He N, McGuire M. Tuberculosis in Canada: 2017)
Proportion of TB cases in Canada 2020 by Population Group
- Canadian Non-Indigenous 9.6%
- Indigenous 1.6%
- Foreign-born cases 73.5%
TB Among Indigenous Peoples of Canada
For most people in Canada, the risk of developing active TB is very low. However, the rates of active TB are higher among Indigenous peoples, and they are particularly high in some Inuit communities.
72.2
Per 100,000 Inuit
2.8
Per 100,000 Métis
13.6
Per 100,000 First Nations
Inuit
The reported rate of active TB among Inuit in Inuit Nunangat was over 400 times the rate of Canadian-born non-Indigenous people in 2017 (205.8 vs 0.5 per 100,000).
This high rate is rooted in multiple factors, including inadequate housing, food insecurity, poverty, stigma, and the enduring impacts of government-led TB control measures during the 1940s and 1950s that transported many Inuit south by ship to TB hospitals thousands of kilometers away from their families and communities. Those who survived did not return home for several years. In some situations, the fate of those who did not return remains unknown.
In 2016, there were approximately 65,000 Inuit living in Canada. Almost three quarters (72.8%) live within four Inuit regions in Canada, collectively known as Inuit Nunangat.
Although there are some significant differences in health status throughout Inuit Nunangat, there are also some common themes across the four regions. According to Statistics Canada, life expectancy for Inuit is 10.5 years lower than the Canadian average; 52% of Inuit live in crowded homes; food insecurity is widespread; and 52.5% of Inuit are unemployed.
In an effort to address the high burden of TB in this region, the Government of Canada and Inuit Tapariit Kanatami (Inuit National Organization) have announced a goal to elimiate TB in the Inuit Nunangut by 2030, and reduce the incidence of active TB by at least 50% by 2025.
First Nations
Tuberculosis has created a significant burden of loss and hardship for First Nations communities. It is a disease fuelled by social factors like overcrowding and poverty and it can flourish among at-risk groups such as people with HIV/AIDS, diabetes and mental health issues.
While rates of TB among First Nations have decreased over the past few decades, they remain high and progress in combating the disease in recent years has slowed.
Métis
While national data suggest that rates of tuberculosis among Métis people are similar to those reported by the general population, a lack of Métis-specific information and incomplete TB surveillance make it challenging to understand the true impact of TB on these communities, particularly in Saskatchewan. Poverty, crowded living conditions, coinfections with HIV, diabetes, and malnutrition are among the factors contribute to TB’s endurance in Métis communities, along with cultural beliefs and barriers that limit access to health services.
“It is assumed that, in northern Saskatchewan, TB is an exclusive problem for First Nations people,” says Clara Morin Dal Col, Métis Nation Minister of Health. “It is a challenge to identify Métis from First Nations TB cases when there are families with Metis and First Nations ancestry or intermarriage, where both communities share the same geographic location and the same social determinants of health disparity.”
Minister Morin Del Col adds that structural changes are needed to meet the health care needs of Métis people: “Many Métis people who live in rural and remote communities do not have easy access to health care facilities. They have to find the money to pay for their transportation to see specialists and to get observed TB treatment in larger urban centres.”
Source: Jetty, R. (2020) Tuberculosis among First Nations, Inuit and Métis children and youth in Canada: Beyond medical management.
Challenges to Health Care Access
Many northern communities in Saskatchewan lack access to full health facilities and hospitals, as such, mobility out of the communities into bigger, often urbanized, destinations is a necessity and often a part of their lifestyle. Above is a map created by our team member Apeksha Heendeniya that highlights this.
Research Findings
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Foreign-Born Population
Although the overall rate in Canada continues to decline, the TB burden is not shared equally. In particular, Canadian-born Indigenous peoples and foreign-born individuals are disproportionately affected.
Distribution of TB cases by population group also varies significantly by jurisdiction. The majority of cases in Alberta, British Columbia, Ontario and Quebec occurred in foreign-born individuals, whereas in Manitoba, Saskatchewan and the Northern territories most cases occurred largely in Aboriginal people. These varied geographic patterns in part reflect differences in the populations among jurisdictions: there are more foreign-born individuals in Ontario, Quebec, British Columbia and Alberta in particular, whereas Aboriginal communities make up a higher proportion of the general population in the prairies and in the North.
While the proportion of all TB cases in Canada among the foreign-born has increased significantly in the past 40 years, the annual number of reported cases has not changed substantially, averaging 1,000 cases per year. Over the past 11 years, however, the incidence rate has declined slowly but steadily, reaching 13.3 per 100,000 in 2010.
Of the foreign-born TB cases reported in Canada from 2000 to 2010 for which the date of arrival was known, 11% were reported within the first year of arrival, 22% within the second year of arrival and 44% within 5 years.
Changing immigration patterns account for some of the changes to this distribution. In addition to increased migration to Canada of people from African, Asian and Pacific regions, these regions also have the highest TB incidence rates, which results in a corresponding shift in Canada’s distribution. Almost one-half of TB cases typically occur within 5 years of arrival in Canada.
Read more at: Canadian Tuberculosis Standards 7th Edition: 2014
Risk Factors for TB
Poverty
A low socioeconomic status (SES) is a strong risk factor for TB. Poverty facilitates the transmission of TB, through its influence on living conditions, reducing access to health services, prolonging diagnostic testing, and increasing susceptibility to TB due to malnutrition and/or comorbidities.
Insufficient Housing
Poor air quality and ventialtion, overcrowding, and the presense of mold and smoke contribute to poor respiratory health and are associated with increased spread and susceptibility to TB.
Limited Access to Healthcare
Poor access to healthcare may result in delayed diagnosis of TB or the disease being undiagnosed. It may lead to treatment delays, missed treatment, or incomplete TB treatment.
Smoking
Smoking increases the risk of active TB by 2-3 fold. Smoking may decrease the immune response and damage airways leading to increase risk for TB.
Food Insecurity
Chronic food insecurity can lead to malnutrition and increased risk for development of TB disease after infection with the TB bacteria.
HIV
HIV weakens the immune system increasing the risk of TB. Untreated LTBI is more likely to advance to active TB in people living with HIV.
Comorbidities
HIV Infection, diabetes mellitus, end-stage renal disease, undernutrition, tobacco use, and alcohol/drug misuse are recognized as comorbidities that may increase the risk of developing TB and may magnify the burden of TB.
Substance Misuse
Alcohol and substance misuse can decrease ones ability to make healthy choices about food and sex. These choices can then impact your body’s ability to fight the TB germ.
Tb & HIV
TB is the leading cause of death among people with HIV/AIDS. Human immunodeficiency virus (HIV) weakens immune systems and allows life-threatening opportunistic infections to flourish. HIV is a major risk factor for progression to active TB, meaning that people living with HIV who become infected with latent TB infection (LTBI) are much more likely to advance to active TB disease than compared to people without HIV. In fact, in countries where TB is very prevalent, people with HIV/AIDS are 20 times more likely to contract and develop active TB than those without HIV.
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