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

Aim: 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. Methods: 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. Results: 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. Conclusion: 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.