Background Tuberculosis (TB) incidence remains disproportionately high in people migrating to Canada and other low TB incidence countries, but systematic TB screening and prevention in migrants is often cost-prohibitive for TB programs. We aimed to develop and validate a TB risk prediction model to inform TB screening decisions in foreign-born permanent residents of Canada. Methods We developed and validated a proportional baselines landmark supermodel for TB risk prediction using health administrative data from British Columbia and Ontario, two distinct provincial healthcare systems in Canada. Demographic (age, sex, refugee status, year of entry, TB incidence in country of origin), TB exposure, and medical (HIV, kidney disease, diabetes, solid organ transplantation, cancer) covariates were used to derive and test models in British Columbia; one model was chosen for external validation in the Ontario cohort. The model’s ability to predict 2- and 5-year TB risk in the Ontario cohort was assessed using discrimination and calibration statistics. Results The study included 715,423 individuals (including 1,407 people with TB disease) in the British Columbia derivation cohort, and 958,131 individuals (including 1,361 people with TB disease) in the Ontario validation cohort. The 2- and 5-year concordance statistic in the validation cohort was 0.77 (95%CI: 0.75-0.78) and 0.77 (95%CI: 0.76-0.78), respectively. Calibration-in-the-large values were 0.14 (95% CI: 0.08-0.21) and -0.05 (95% CI: -0.12-0.02) in 2- and 5-year prediction windows. Conclusions This prediction model, available online at https://tb-migrate.com, may improve TB risk stratification in people migrating to low incidence countries and may help inform TB screening policy and guidelines.

中文翻译：

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预测迁移到结核病低发病率国家/地区的人群患结核病的风险：使用卫生管理数据开发和验证多变量动态风险预测模型


背景 移民到加拿大和其他结核病发病率低国家的人群中，结核病 （TB） 发病率仍然不成比例地高，但对于结核病计划来说，移民的系统性结核病筛查和预防往往成本高昂。我们旨在开发和验证结核病风险预测模型，为加拿大外国出生的永久居民的结核病筛查决策提供信息。方法我们使用来自加拿大两个不同的省级医疗保健系统不列颠哥伦比亚省和安大略省的卫生管理数据开发并验证了用于结核病风险预测的比例基线里程碑超模型。在不列颠哥伦比亚省，人口统计学（年龄、性别、难民身份、入境年份、原籍国的结核病发病率）、结核病暴露和医学（HIV、肾病、糖尿病、实体器官移植、癌症）协变量用于推导和测试模型;在安大略省队列中选择了 1 个模型进行外部验证。使用鉴别和校准统计评估该模型预测安大略省队列中 2 年和 5 年结核病风险的能力。结果 该研究在不列颠哥伦比亚省推导队列中包括 715,423 人（包括 1,407 名结核病患者），在安大略省验证队列中包括 958,131 人（包括 1,361 名结核病患者）。验证队列中的 2 年和 5 年一致性统计量分别为 0.77 （95% CI： 0.75-0.78） 和 0.77 （95% CI： 0.76-0.78）。在 2 年和 5 年预测窗口中，大校准值为 0.14 （95% CI： 0.08-0.21） 和 -0.05 （95% CI： -0.12-0.02）。结论 该预测模型可在 https://tb-migrate.com 在线获得，可能会改善迁移到低发病率国家/地区的人群的结核病风险分层，并可能有助于为结核病筛查政策和指南提供信息。