Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK.
Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK.
复制标题
DOI：
10.12688/f1000research.14476.1
复制
发表时间：
2018-01-01
期刊：
影响因子：
--
通讯作者：
Tanner, Rachel
中科院分区：
文献类型：
--
作者：
Hayward, Sally;Harding, Rosalind M;Tanner, Rachel
与普通人群相比，英国的移民和少数民族的结核病(TB)发病率更高。从历史上看，英国出生人口和移民人口之间的发病率差异在很大程度上归因于不同的病原体暴露，这是由于来自高发地区的移民以及与结核病出生国或种族起源的流行国家保持的跨国联系。然而，仅专注于暴露并不能解决在一些潜伏感染人群中观察到的相对较高的活动性疾病进展速度。对移民和少数族裔造成不成比例影响的一系列因素，包括遗传易感性、维生素D缺乏以及糖尿病和艾滋病毒等共病，也增加了感染结核分枝杆菌或重新激活潜伏感染的风险。此外，族裔社会经济差异和移徙经历本身可能导致结核病发病率的差异，以及获得医疗保健的文化和结构性障碍。在这篇综述中，我们讨论了与病原体暴露的风险、感染的易感性或活动性疾病的发展以及英国移民和少数民族获得治疗的机会有关的生物学和人类学影响。
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.