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Background <p>In tuberculosis (TB) low-incidence countries, TB is becoming increasingly concentrated in marginalised populations. Progress towards TB elimination therefore requires targeted interventions informed by knowledge on the determinants of disease in specific subpopulations. In Denmark, Greenlanders experience an exceptionally high TB incidence, approximately 170-fold higher than that of Danish-born individuals. Despite comprising only 0.3% of the population, Greenlanders account for around 20% of TB cases. In this study we identify and quantify risk factors for TB among Greenlanders living in Denmark.</p> Methods <p>We conducted a nationwide retrospective cohort study including all Greenlandic-born individuals aged ≥ 18 years living in Denmark, 2005–2022. Individual-level demographic, socioeconomic and health data were linked across national registries and TB cases were identified through the National TB Surveillance Register. We calculated incidence rates and time to TB after arrival in Denmark and assessed risk-factors for TB using Andersen-Gill Cox proportional hazards regression models with annual time-varying covariates and recurrent events.</p> Results <p>A total of 23,345 Greenlandic-born individuals contributed with 240,391 person-years of follow-up. The overall TB incidence was 341 per 100,000 person-years, with 76.1% of cases occurring in the five largest cities and incidences rates exceeding 1,000 per 100,000 in Copenhagen and Esbjerg. Independent risk factors included male sex, age 40–59 years, alcohol use disorders, homelessness, low education, unemployment, retirement and receipt of social welfare benefits. Comorbidity was not independently associated with TB risk.</p> Conclusions <p>TB among Greenlanders in Denmark is strongly linked to social deprivation and concentrated in urban settings. In addition to medical interventions, targeted social and structural measures addressing the underlying determinants that drive deprivation are essential to advance TB control and elimination among Greenlanders in Denmark.</p>

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Risk factors for tuberculosis: a nationwide cohort study among Greenlanders in Denmark, 2005–2022, highlighting social vulnerability

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  • 发表日期：

    2026年7月31日

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  • Anja Leo Rossel,
  • Karsten Fleischer Rex,
  • Christian Holm Hansen,
  • Anders Koch,
  • Troels Lillebaek

摘要

Background

In tuberculosis (TB) low-incidence countries, TB is becoming increasingly concentrated in marginalised populations. Progress towards TB elimination therefore requires targeted interventions informed by knowledge on the determinants of disease in specific subpopulations. In Denmark, Greenlanders experience an exceptionally high TB incidence, approximately 170-fold higher than that of Danish-born individuals. Despite comprising only 0.3% of the population, Greenlanders account for around 20% of TB cases. In this study we identify and quantify risk factors for TB among Greenlanders living in Denmark.

Methods

We conducted a nationwide retrospective cohort study including all Greenlandic-born individuals aged ≥ 18 years living in Denmark, 2005–2022. Individual-level demographic, socioeconomic and health data were linked across national registries and TB cases were identified through the National TB Surveillance Register. We calculated incidence rates and time to TB after arrival in Denmark and assessed risk-factors for TB using Andersen-Gill Cox proportional hazards regression models with annual time-varying covariates and recurrent events.

Results

A total of 23,345 Greenlandic-born individuals contributed with 240,391 person-years of follow-up. The overall TB incidence was 341 per 100,000 person-years, with 76.1% of cases occurring in the five largest cities and incidences rates exceeding 1,000 per 100,000 in Copenhagen and Esbjerg. Independent risk factors included male sex, age 40–59 years, alcohol use disorders, homelessness, low education, unemployment, retirement and receipt of social welfare benefits. Comorbidity was not independently associated with TB risk.

Conclusions

TB among Greenlanders in Denmark is strongly linked to social deprivation and concentrated in urban settings. In addition to medical interventions, targeted social and structural measures addressing the underlying determinants that drive deprivation are essential to advance TB control and elimination among Greenlanders in Denmark.